Clinical Pearls

Treat a documented suicide attempt in the last 2 years of active duty as a major transition-risk marker: in VHA users, 14.3% had a postseparation suicide attempt versus 1.4% without that history (RR [95% CI]=7.78 [7.10–8.52]).

Do not assume VHA linkage will happen automatically after separation. Even in this high-risk group, 3,199 [60.7%] used any VHA services in the first 2 years after separation, meaning nearly 4 in 10 did not connect.

Once a recently separated Veteran with a prior military suicide attempt enters VHA, keep specialty mental health follow-up active. Among those connected to VHA, 2,875 [89.9% of those connected to VHA] used mental health services and 563 [17.6%] had a high risk for suicide flag.

Postseparation safety planning should address more than suicide alone. In the first 2 years after separation, suicide caused 914 of 2,283 deaths (40.0%) and accidents caused 718 (31.4%), with 39.4% of accidental deaths due to poisonings, including drug overdoses.

A recent active duty suicide attempt identifies a subgroup with sharply elevated mortality after discharge. In the 2 years after separation, suicide mortality was nearly 10 times expected (SMR 9.9; 95% CI, 7.4, –13.1) and all-cause mortality was also elevated (SMR 5.5; 95% CI, 4.2–7.1).