Mental Health
Cumulative bone lead and firearm use associated with suicidal ideation and depression in Veterans. Gabrielle Groth Hoover* Christian Hoover Aaron Specht Mu-Yin Chang Camille Lanne Marquez Katelyn Elizabeth Rand Katherine Beavis
Veterans are at risk for elevated lead exposure, depression, and suicidal ideation. Suicide is associated with firearms, which may be associated with lead exposure from ammunition. Lead may also be related to symptoms of depression and suicidal ideation; this is poorly understood due to a focus on acute, rather than cumulative, measures and a failure to consider firearms in the lead-depression link. To address this gap, we leverage data from an ongoing cohort study of Veterans in psychiatric treatment using self-report measures of psychopathology (Patient Health Questionnaire, PHQ-9), clinician interviews, firearm and exposure surveys, and in vivo x-ray (Bone) scans. Preliminary analyses included 135 participants who were 79% White, 75% Male, and middle-aged (median = 43 years). A median split with fisher’s exact test examined unadjusted associations between lead, suicidal ideation, and firearm ownership. A logistic ordinal regression assessed lead as a continuous variable over four levels of suicidal ideation. A linear regression examined total PHQ-9 scores as a continuous outcome, controlling for bone lead, firearms, military service history, other mental illness, and demographics. Individuals who had high bone lead levels were 2.7 times (95% CI: 1.20, 6.00) more likely to endorse suicidal ideation while gun owners had 1.7 times higher odds of having high bone lead levels. Logistic regression found increases in lead levels associated with significant increases in the odds of higher severity of suicidal symptoms at each threshold, ranging from 3.7 (none:mild) to 49.7 (moderate:severe). Linear regression found a unit increase in bone lead associated with a 10.2% increase in PHQ-9 symptoms (95% CI: 1.02, 1.2). Results suggest cumulative bone lead levels are significantly associated with suicidal ideation and depression. While there is some evidence that firearm ownership is associated with lead exposure, more research is needed in a complete sample.