Saulnier Kevin G, Philibert Anna L, Grau Peter P, Bowersox Nicholas W
Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Ann Arbor, Michigan.
Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan.
J Clin Psychiatry. 2025 Mar 12;86(2):24m15424. doi: 10.4088/JCP.24m15424.
To evaluate factors associated with suicide mortality among Veterans Health Administration (VHA) patients with bipolar disorder. VHA patients diagnosed with bipolar disorder in calendar year (CY) 2014 who utilized VHA health care services in CY2013 were included in the study cohort. Suicide mortality in the 5 years following the first documented bipolar disorder diagnosis during CY2014 was examined using Cox proportional hazards regression. 725 of 126,655 VHA patients who had a bipolar disorder diagnosis in CY2014 (0.6%) died by suicide in the following 5 CYs (2014-2019). Suicide was associated with suicide high-risk flags (hazard ratio [HR] = 2.21), prior year emergency department visit (HR = 1.25), having a new bipolar disorder diagnosis (HR= 1.23), and receiving a benzodiazepine prescription of ≥30 days of supply (HR = 1.58). Prescriptions of benzodiazepines of <30 days of supply, other anxiolytics (ie, buspirone), and sedatives were not significantly associated with suicide mortality in the multivariable model. Among VHA patients diagnosed with bipolar disorder, receipt of a benzodiazepine prescription of ≥30 days was associated with increased suicide risk, even after controlling for clinical and demographic factors. Elucidating mechanisms through which benzodiazepine prescriptions increase suicide risk is an important avenue for future investigations. Additionally, VHA patients with newly diagnosed bipolar disorder may benefit from increased clinical attention, given the elevated suicide risk among this subgroup. Findings highlight targets for suicide prevention initiatives.
评估退伍军人健康管理局（VHA）双相情感障碍患者自杀死亡的相关因素。研究队列纳入了2014日历年被诊断为双相情感障碍且在2013日历年使用过VHA医疗服务的VHA患者。使用Cox比例风险回归分析2014日历年首次记录双相情感障碍诊断后的5年自杀死亡率。2014日历年126,655名被诊断为双相情感障碍的VHA患者中有725人（0.6%）在随后的5个日历年（2014 - 2019年）自杀死亡。自杀与自杀高风险标志（风险比[HR]=2.21）、上一年急诊就诊（HR = 1.25）、新诊断为双相情感障碍（HR = 1.23）以及接受供应≥30天的苯二氮䓬类药物处方（HR = 1.58）有关。在多变量模型中，供应<30天的苯二氮䓬类药物、其他抗焦虑药（即丁螺环酮）和镇静剂的处方与自杀死亡率无显著关联。在被诊断为双相情感障碍的VHA患者中，即使在控制临床和人口统计学因素后，接受供应≥30天的苯二氮䓬类药物处方仍与自杀风险增加有关。阐明苯二氮䓬类药物处方增加自杀风险的机制是未来研究的重要方向。此外，鉴于新诊断为双相情感障碍这一亚组的自杀风险升高，VHA新诊断为双相情感障碍的患者可能受益于更多的临床关注。研究结果突出了自杀预防举措的目标。
