Graded Associations of Tranquilizer Use and Misuse with Suicidal Thoughts and Behaviors in a National Sample of U.S. Veterans.

U.S. military veterans face an elevated suicide risk compared to the general population. Both the use and misuse of tranquilizers (i.e. several classes of medications that treat anxiety and muscle spasms via central nervous system action, including benzodiazepines) have been associated with suicidal thoughts and behaviors among veterans. However, it remains unclear whether risk varies across different patterns of tranquilizer use. Participants included 12,584 U.S. military veterans (13.0% female; 78.1% non-Hispanic White; 49.3% age 65 and older), from the 2015-2019 National Survey on Drug Use and Health (NSDUH). Tranquilizer use without misuse was associated with greater odds of suicidal ideation and planning, relative to nonuse (p's < 0.01). Tranquilizer misuse was associated with greater odds of suicide ideation, planning, and attempts compared to nonuse (p's < 0.01). Relative to use without misuse, tranquilizer misuse was associated with greater odds of suicide ideation, planning, and attempts (p's < 0.01). These results support a graded association between tranquilizer use/misuse and suicidal thoughts and behaviors, suggesting that risk for suicide-related outcomes may increase from no use, to use without misuse, to misuse. Future research should explore the clinical utility of addressing tranquilizer use/misuse as part of targeted suicide prevention strategies among veterans.