Suicide risk management in the Department of Veterans Affairs (VA) health care system is particularly challenging because of both patient characteristics and aspects of the delivery system. The prototypical suicide-prone person is an older white male with alcoholism, depression, physical problems, and poor psychosocial support. This describes a large portion of the veteran patient population. Suicide risk factors that are common in VA patients include male gender, older age, diminished social environment support (exemplified by homelessness and unmarried status), availability and knowledge of firearms, and the prevalence of medical and psychiatric conditions associated with suicide. A variety of characteristics of the VA system complicate suicide management. Efforts under way to emphasize ambulatory care and decrease the VA culture of reliance on inpatient treatment heighten the importance of accurate suicide assessment. The authors recommend several strategies that VA administrators can consider for improving the assessment and management of veterans with long-term suicide risk factors.

Inpatients in Veterans Administration substance-abuse treatment programs voluntarily took the Minnesota Multiphasic Personality Inventory (MMPI) as part of a routine clinical evaluation. The alcohol-dependence-only group (n = 207) were older (M = 49.6 years) and had a higher percentage of White Ss (72.9%) than did either the drug-dependence group (n = 49, M = 32.9 years, Whites = 5 3.1%) or a mixed alcohol-and drug-dependence group (n = 160,M= 35.0 years, Whites = 60.0%). Previously reported differences between alcoholics and drug abusers in depression and psychopathy were obtained when age and race were not used as covariates, but no differences were found when the effects of age and race were statistically controlled. Mixed alcohol and drug abusers had somewhat more pathological MMPI scores than did alcoholics, even when effects due to age and race were partialed out.Previous comparisons of alcoholics and drug abusers on the Minnesota Multiphasic Personality Inventory (MMPI) have shown that alcoholics have higher levels of anxiety, depression, and somatic concerns and that drug abusers tend to be more psychopathic (Holland, 1977;Kranitz, 1972;Overall, 1973). One methodological problem shared by these studies has been the lack of control for the effect of age on the MMPI. Alcoholics in treatment typically are older than drug abusers in treatment (Keskinen, 1987; cf. Method section), and age is known to be correlated with MMPI scores in both the general psychiatric population (e.g.

Malignant Post-Vietnam Stress Syndrome describes a severe form of combat-related posttraumatic stress disorder. We update the concept of Malignant Post-Vietnam Stress Syndrome, considering the effects of repeated severe traumatization, exposure to atrocities, and a variety of comorbid conditions. An illustrative case report demonstrates an interdisciplinary treatment approach, combining case management, brief hospitalizations, symptom-directed use of medications, and supportive psychotherapy.

No abstract