Violent Behavior, Alcohol Use Linked to Suicide Attempts in Veterans With PTSD

Sad soldier in uniform covering his mouth while sitting on a sofa
Violent behavior, alcohol use, and suicidal ideation were associated with suicide attempts by veterans, both prior to admission into specialized intensive PTSD programs run by the Veterans Health Administration and after discharge.

Psychiatric and substance abuse comorbidity, suicidal ideation, and violent behavior are predictive factors of postdischarge suicide attempt among veterans enrolled in specialized intensive posttraumatic stress disorder (PTSD) programs, according to study data published in the Journal of Clinical Psychiatry.

Investigators abstracted data from an administrative evaluation performed by the Veteran’s Health Association of specialized intensive PTSD treatment programs between 1993 and 2011. According to evaluation protocol, patients completed a structural baseline assessment at program intake and four months after discharge. Assessment interviews captured sociodemographic factors, psychiatric symptoms, and suicide attempts. The Addiction Severity Index was used to assess alcohol and drug use. Bivariate analyses and multivariable logistic regression were performed to identify baseline factors associated with suicide attempt before enrollment and following discharge.

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Baseline and postdischarge data were obtained from 30,384 veterans treated at 57 program sites. Rates of suicide attempt were 10.6% in the four months prior to baseline and 3.4% in the four months following discharge. Baseline suicide attempt was associated with significantly higher scores on measures of suicidal ideation and violent behavior (both P <.001), as well as greater scores on the Addiction Severity Index alcohol composite index (P =.004) and drug composite index (P <.001). Postdischarge suicide attempt was also associated with suicidal ideation and violent behavior (both P <.001) but not with baseline alcohol use. Postdischarge suicide attempt was also associated with the following changes in symptoms from baseline to follow-up: increased score on the suicidal thoughts subscale, increased score on the violent behavior subscale, and increased score on the alcohol composite index (all P <.001).

These longitudinal data show that suicidal ideation, violent behavior, and alcohol use were each independently associated with suicide attempts in veterans with PTSD. As an observational retrospective study, definitive causality between longitudinal factors and suicide attempt could not be established. To curb this limitation, multiple regression analyses was used to control for potential confounders; even so, results should be interpreted with care.

“Additional therapeutic attention to violent behavior and alcohol use…may help reduce the risk of suicide attempts,” investigators concluded.


Stefanovics EA, Rosenheck RA. Predictors of post-discharge suicide attempt among veterans receiving specialized intensive treatment for posttraumatic stress disorder. J Clin Psychiatry. 2019;80(5):19m12745.