Higher Suicide Risk Found for US Veterans With ALS

Military veterans with amyotrophic lateral sclerosis (ALS) are nearly four times as likely to commit suicide as vets without the progressive neurological disease, according to a recent study.

This finding suggests that the Veterans Health Administration (VHA) should increase their suicide prevention efforts among veterans with ALS.

The study, “Suicide among Veterans with Amyotrophic Lateral Sclerosis,” was published in the journal Muscle & Nerve.

Depression rates often are higher among people with ALS but the overlap in symptoms between the two disorders can cause doctors to overlook depression.

Relatively little is known about suicide in the context of ALS. Past studies have indicated it more frequent in ALS patients than among the general population, and that it more often occurs in the earlier stages of the disease. The true rate and predictors of suicide, however, remain unknown.

To learn more, a team of researchers working for the VHA, the University of Alabama, and the University of Colorado Anschutz now looked to VHA records as a source of information for ALS-associated suicide rates.

The VHA has a large patient population, implying a robust dataset. As a federally funded healthcare system, its providers cannot legally offer or suggest alternatives to suicide such as physician-hastened death (PHD). Furthermore, with veteran suicide rates in the U.S. 1.5 to 2.5 higher than among civilians, suicide prevention is an important service with room for improvement.

Here, the investigators obtained records from 7,397 individuals with ALS and from 1,546,850 veterans without the disease. From this population, they evaluated suicide risk between patients with and without ALS. The team also assessed how demographics and other medical conditions affect suicide rates among veterans with ALS, and determined which suicide methods are used.

Demographically, the largest difference between groups appeared in the proportion of Black veterans. Approximately 5.5% of vets with ALS were Black or African-American. This nearly doubled to 10.2% of the population without ALS, while the proportions of other racial groups varied less.

Vets with ALS were more likely than others to have depression and other depressive mood disorders (36% vs 24.7%) and to have anxiety disorders (17.9% vs 14.1%). They also were more likely overall to have other medical disorders, including mild traumatic brain injury and nerve disorders.

Within this population, vets with ALS were 3.98 times more likely overall to commit suicide than other vets. The difference increased slightly when adjusting for age and gender. It remained significant when other factors, including psychiatric diagnoses and other health disorders, were taken into account.

Of the 23 ALS patients who died by suicide, 21 (91.3%) used firearms, compared to 74.7% of those without ALS.

Given the apparent access to firearms by vets with ALS, as well as their physical ability and desire to use them, the investigators stress that providers should seek ways to reduce veterans’ access to lethal means during high-risk periods.

Although more work is needed to define these periods, assessing the time span between ALS diagnosis and suicide, the results of the present study call attention to potentially underserved mental and physical health needs of vets with ALS.

More could be done, the investigators suggested, to improve how difficult diagnoses are communicated, and to ensure that palliative, or end-of-life care is not confused with PHD.

Their findings, the team concluded, “strongly support engaging veterans with ALS and their caregivers in firearm lethal means counseling, perhaps even prior to the provision of a definitive diagnosis.”

Notably, the investigators said further research on the use of firearms in suicide “is warranted” in non-veteran U.S. populations. “Of note, the use of firearms as the predominant means of suicide may be specific to US military veterans,” the team said.