ANN ARBOR, Mich. - When Lamont Christian returned from war, he often felt angry, afraid and unworthy. Years later, Christian found himself living in a homeless shelter, a sign that time had not healed his emotional wounds.
He went to the VA Ann Arbor Healthcare System for help, and there, he learned the root of his problems: he was suffering from depression, post-traumatic stress disorder and anger management problems. Now, he wants others to learn from his experience.
"If I had a message to give to veterans who are coming out of the military now or even veterans who have been out for a long period of time, it's that nothing is going to happen in your life unless you go and get the help you need," he says.
Christian is a veteran of Vietnam, but his experience holds true for soldiers returning from current battlegrounds as well.
Nearly a third of veterans who are treated at Veterans Affairs health care centers have significant depressive symptoms, and about 13 percent have clinically diagnosed depression, says Marcia Valenstein, M.D.,
clinical psychiatrist with the VA Ann Arbor Healthcare System
and associate professor of psychiatry with the University of Michigan Health System. Valenstein is a member of the U-M Depression Center
Depression is a "very potent" risk factor for suicide among people receiving treatment for depression at the VA, she notes, with a suicide rate that is three times higher than that of the overall VA patient population.
Such high rates led Valenstein and her colleagues to study the best time to provide intensive interventions to veterans with depression to prevent suicide. In a study just published by the Journal of Affective Disorders, the researchers found that veterans with depression were at highest risk for suicide in the 12 weeks after they were hospitalized for psychiatric conditions.
"This finding highlights the need for very close follow-up for patients who are discharged from our inpatient services because this is a particularly vulnerable time for them," says Valenstein, a core investigator with the Serious Mental Illness Treatment Research and Evaluation Center at the VA Ann Arbor Healthcare System.
Current government recommendations have focused on providing intensive follow up for patients following all new antidepressant starts. More attention needs to be paid to the highest-risk periods that follow psychiatric hospitalization, Valenstein says. "Health systems with limited resources should focus their efforts on this time period to have the greatest impact on suicide prevention."
The Department of Veterans Affairs has made mental health issues a priority, Valenstein notes. VA health centers have received more than $300 million for expansion of suicide prevention and other mental health services from the Veterans Health Administration.
Note: The views expressed in the study are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
Authors: In addition to Valenstein, authors of the paper were Hyungjin Myra Kim, Dara Ganoczy, John F. McCarthy, Kara Zivin, Karen L. Austin, Katherine Hoggatt, Daniel Eisenberg, John D. Piette and Frederic C. Blow, all with affiliations at the VA Ann Arbor Healthcare System, the University of Michigan Medical School, and/or the University of Michigan School of Public Health; and Mark Olfson of Columbia University.
Funding: The research was supported by grants from the Department of Veterans Affairs, Health Services Research and Development Service, and the National Institute of Mental Health. Resources also were contributed by the Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, Mich. The sponsors provided funding but otherwise were not involved in the study.
Reference: Journal of Affective Disorders, Jan. 2009, "Higher-risk periods for suicide among VA patients receiving depression treatment: Prioritizing suicide prevention efforts."
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