Long-term Psychoactive Medications, Polypharmacy, and Risk of Suicide and Unintended Overdose Death Among Midlife and Older Women Veterans

Abstract

Background Rates of suicide and unintended overdose death are high among midlife and older women, yet there is paucity of data identifying women at greatest risk. Psychoactive medications, commonly prescribed and co-prescribed in this population, may serve as salient indicators of risk for these outcomes. Objective To determine whether long-term psychoactive medications and psychoactive polypharmacy predict risk of suicide and unintended overdose death among midlife and older women Veterans above and beyond other recognized factors. Design Longitudinal cohort study Participants Women Veterans aged ≥ 50 with at least one Veterans Health Administration (VHA) clinical encounter in FY2012–2013. Main Measures Long-term psychoactive medications (opioids, benzodiazepines, sedative-hypnotics, antidepressants, antipsychotics, and antiepileptics, prescribed for ≥ 90/180 days) and psychoactive polypharmacy (overlapping for ≥ 1 day) from VHA pharmacy records; suicide and unintended overdose death through December 31, 2018. Key Results In this national sample of 154,558 midlife and older women Veterans (mean age 63.4, SD 9.3 years), 130 died by suicide and 175 died from unintentional overdose over an average of 5.6 years. In fully adjusted models, long-term opioids (hazard ratio (HR) 2.01, 95% CI 1.21–3.35) and benzodiazepines (HR 2.99, 95% CI 1.82–4.91) were associated with death by suicide; opioids (HR 3.62, 95% CI 2.46–5.34), benzodiazepines (HR 2.77, 95% CI 1.73–4.42), sedative-hypnotics (HR 1.87, 95% CI 1.06–3.29), antidepressants (HR 1.47, 95% CI 1.03–2.12), antipsychotics (HR 1.81, 95% CI 1.02–3.22), and antiepileptics (HR 2.17, 95% CI 1.48–3.19) were associated with unintended overdose death. Women who were co-prescribed ≥ 3 psychoactive medications had over 2-fold increased risk of suicide (HR 2.83, 95% CI 1.65–4.84) and unintended overdose death (HR 2.60, 95% CI 1.72–3.94). Conclusions Long-term psychoactive medications and psychoactive medication polypharmacy were important indicators of risk for death by suicide and death by unintended overdose among midlife and older women Veterans, even after accounting for psychiatric and substance use disorders.

Comorbidity and polypharmacy impact neurobehavioral symptoms and symptom validity failure among post-9/11 veterans with mild traumatic brain injury

“…Older veterans appear to be at a particular risk for adverse outcomes associated with polypharmacy, including morbidity, mortality, and suicide ( 5 , 19 , 32 ). Moreover, polypharmacy itself has been repeatedly associated with a greater risk for suicide-related behaviors ( 4 , 19 , 33 ). Similar to the existing literature on CNS polypharmacy among older adults, post-911 veterans were also susceptible to severe adverse reactions secondary to having multiple CNS-acting medications on hand to manage co-existing chronic conditions.…”

Use of Psychoactive Medications and Risk of Suicide in Late Life (75+): A Total Population Study

“…Among older adults aged 75+ in Sweden, about four out of ten are prescribed psycholeptic medications (antipsychotics, hypnotics or anxiolytics) and about one-fifth are on antidepressants [ 7 ]. Psychoactive medications are commonly used for suicide [ 8 , 9 ]. Further, emergency department visits for self-harm involving prescribed medications are significantly more common in older adults [ 10 ].…”