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OtherANALYSIS AND COMMENTARY

Suicide Among Incarcerated Veterans

Hal S. Wortzel, Ingrid A. Binswanger, C. Alan Anderson and Lawrence E. Adler
Journal of the American Academy of Psychiatry and the Law Online March 2009, 37 (1) 82-91;
Hal S. Wortzel
MD
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Ingrid A. Binswanger
MD, MPH
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C. Alan Anderson
MD
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Lawrence E. Adler
MD
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    Figure 1.

    Incarcerated veterans are at the intersection of two populations with elevated suicide rates. The risk incurred by this status remains unknown.

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    Table 1

    Suicide Among Veterans in the General Population

    Thompson et al.5Suicide rate two to three times that of the general population. Depression, psychotic disorders, and substance abuse associated.
    Price et al.6Major depression and drug dependence with largest effect on the timing of suicidality.
    Zivin et al.7Male, white race, substance abuse associated. Younger veterans (age 18–44) have higher rates. Service connection is a protective factor.
    Desai et al.8Higher rates in younger and older veterans. Bipolar disorder with highest rates. PTSD/anxiety disorders marginally protective. $100 per capita increased spending approximate six percent reduction in suicide.
    Kaplan et al.9Suicide rate approximately two times that of the general population. White race, ≥12 years’ education, activity limitations with greater risk.
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    Table 2

    Suicide in Jails and Prisons

    Shaw et al.20Rate 133 per 100,000; 32% within first seven days; male/female ratio, 12:1; 18% age 21 or younger; 26% with violent crimes, 49% on remand; 72% with one or more psychiatric diagnoses. Drug dependence most frequent primary and secondary diagnosis.
    Fazel et al.21Rate approximately five times that of the general population. Excess risk among male prisoners on rise.
    Blaauw et al.22Six characteristics useful in identifying potential victims: age 40+, homelessness, history of psychiatric care, drug abuse, prior incarceration, violent offense.
    Matschnig et al.23Increased suicide rates and rates on the rise. Pretrial with highest risk. Long-term sentences, single-cell use, mental illness, substance abuse, history of suicidality associated with increased risk.
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    Table 3

    Incarcerated Veterans

    Rosenheck et al.1915.7% of male VA mental health patients incarcerated at some point between 1994 and 1997; 39.6% of those age 18–39 years. Incarceration rates highest with young age, substance use, and mental health disorders.
    Saxon et al.31Of incarcerated veterans, 87% reported at least one lifetime traumatic event, and 39% screened positive for PTSD. Unemployment and homelessness frequently preceded incarceration. Substantial drug and alcohol use noted.
    McGuire et al.32Of the incarcerated veterans, 21% had long-term homelessness, 73% were unemployed. Current drug and alcohol abuse affected 37% and 50%. Psychiatric illness was present in 35%, 23% with dual diagnosis, 15% with mood disorders, 7% with schizophrenia, 6% with PTSD.
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Journal of the American Academy of Psychiatry and the Law Online: 37 (1)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 37, Issue 1
March 2009
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Suicide Among Incarcerated Veterans
Hal S. Wortzel, Ingrid A. Binswanger, C. Alan Anderson, Lawrence E. Adler
Journal of the American Academy of Psychiatry and the Law Online Mar 2009, 37 (1) 82-91;

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Suicide Among Incarcerated Veterans
Hal S. Wortzel, Ingrid A. Binswanger, C. Alan Anderson, Lawrence E. Adler
Journal of the American Academy of Psychiatry and the Law Online Mar 2009, 37 (1) 82-91;
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