Depressive symptoms and other risk factors predicting suicide in middle-aged men: a prospective cohort study among Korean Vietnam War veterans

Abstract

Background. Few studies have prospectively examined whether depressive symptoms and other risk factors are associated with a higher risk of suicide death in individuals other than high-risk populations such as psychiatric patients and individuals with self-harm histories. The purpose of the study is to prospectively examine whether depressive symptoms assessed by the Beck Depression Inventory (BDI) are associated with greater risk of suicide death and whether depressive symptoms and other risk factors are independent predictors of suicide in general-risk populations. Another aim is to evaluate the sensitivity of the BDI for predicting suicide death.Methods. 10,238 Korean Vietnam War veterans (mean age: 56.3 years) who participated in two surveys in 2001 were followed up for suicide mortality over 7.5 years.Results. 41 men died by suicide. Severely depressed participants had a higher adjusted hazard ratio (aHR = 3.4; 95% CI [1.5–7.7]) of suicide than non-to-moderately depressed ones. Higher suicide risk was associated with more severe depressive symptoms (p for trend = 0.009). After adjustment for depressive symptoms and other factors, very poor health, low education, and past drinking were associated with higher suicide risk, while good health, body mass index, and marital status were not associated with suicide. The sensitivity at the cut-off score of 31 for detecting suicide was higher during the earlier 3.5 years of the follow-up (75%; 95% CI [50–90]) than during the latter 4 years (60%; 95% CI [41–76]).Conclusions. Depressive symptoms are a strong independent predictor and very poor health, low education, and drinking status may be independent predictors of future suicide. The BDI may have acceptable diagnostic properties as a risk assessment tool for identifying people with depression and suicidal potential among middle-aged men.

Usual alcohol consumption and suicide mortality among the Korean elderly in rural communities: Kangwha Cohort Study

“…The alcohol intake amount (grams of alcohol) per week was classified into four groups (grams of alcohol per week (drinks per week, with 1 drink as 14 g of alcohol 16 ; non-drinkers, <70 (<5 drinks); 70-209 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14), 210-419 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), and ≥420 (≥30)). The amount consumed (grams of alcohol) per drinking day was classified into four groups (grams of alcohol per drinking day (drinks per occasion); non-drinkers, <70 (<5 drinks); 70-139 (5-9), and ≥140 (≥10)).…”

Disease-related mortality among 21,609 Norwegian male military peacekeepers deployed to Lebanon between 1978 and 1998

“…27 Among Korean Vietnam veterans who participated in surveys in 2001, severely depressed participants had a three-fold higher risk of suicide than those who reported no, or only moderate depression. 20 The increased risk in our cohort might be explained by indirect evidence of possible pathways between combat exposure and increased suicide risk via the link between PTSD and observations of increased suicide risk among veterans with PTSD. 16 18 Unfortunately, we did not have information of PTSD among our cohort members.…”

“…An elevated risk of suicide post discharge has also been observed among veterans; [16][17][18][19] depression, 20 posttraumatic stress disorder (PTSD) 16 and being wounded by hostile forces 21 seem to increase this risk.…”

External-cause mortality among 21 609 Norwegian male military peacekeepers deployed to Lebanon between 1978 and 1998

“…The risk factors for suicide include mental disease and depression, chronic physical illness and exposure to a traumatic event 27. Among Korean Vietnam veterans who participated in surveys in 2001, severely depressed participants had a threefold higher risk of suicide than those who reported no, or only moderate depression 20. The increased risk in our cohort might be explained by indirect evidence of possible pathways between combat exposure and increased suicide risk via the link between PTSD and observations of increased suicide risk among veterans with PTSD 16 18.…”

“…An elevated risk of suicide post discharge has also been observed among veterans;16–19 depression,20 post-traumatic stress disorder (PTSD)16 and being wounded by hostile forces21 seem to increase this risk.…”