Article Summary
Clinical Summary: Suicide Risk and Veterans Health Administration Utilization Among Those With a Documented Suicide Attempt in the US Military
Veterans are at elevated suicide risk after leaving military service, and risk is especially concerning for those who attempted suicide shortly before separation. This study identifies how often that high-risk group connects with Veterans Health Administration care after discharge and how much postseparation suicide and mortality risk persists in the first 2 years.
Design
this retrospective cohort evaluation
N
1,030,599 unique individuals
Population
Service members who separated from the Active component (AC) of the Air Force, Army, Marine Corps, or Navy from January 1, 2015, through December 31, 2020
Duration
the 2 years following an individual’s separation date
Key Findings
- In the first 2 years after separation, any VHA service utilization was higher among those with an active duty suicide attempt than those without: 3,199 [60.7%] vs 472,002 [46.0%].
- Among those who utilized VHA care, documented postseparation suicide attempts occurred in 14.3% of those with a recent active duty suicide attempt versus 1.4% of those without, with adjusted RR [95% CI]=7.78 [7.10–8.52].
- Among Veterans with an active duty suicide attempt who connected to VHA, 2,875 [89.9% of those connected to VHA] had any mental healthcare utilization in the first 2 years after separation, compared with 273,797 [58.0%] among those without an active duty suicide attempt.
- Individuals with an active duty suicide attempt were more likely to have a high risk for suicide flag in the VHA EHR after separation than those without: 563 [17.6%] vs 7,528 [1.6%].
- Compared with those without an active duty suicide attempt, postseparation mortality risk was substantially higher for those with a recent military attempt: suicide SMR 9.9; 95% CI, 7.4, –13.1 and all-cause mortality SMR 5.5; 95% CI, 4.2–7.1.
Clinical Bottom Line
A documented suicide attempt in the last 2 years of active duty identifies a small but extremely high-risk group after military separation. Rapid linkage to VHA care is important, but persistent rates of recurrent suicide attempt, suicide death, and all-cause mortality show that this group needs intensive follow-up in the first 2 years after discharge.
Practice Implications
- Treat a recent active duty suicide attempt as a major transition-risk marker and prioritize proactive follow-up during the first 2 years after separation, when this study tracked markedly elevated recurrent attempt and mortality risk.
- Actively connect separating service members with recent suicide attempts to VHA services, because 3,199 [60.7%] used any VHA care after separation, meaning 39.3% did not connect despite very high risk.
- For Veterans with a recent military suicide attempt who enter VHA, maintain close suicide risk monitoring and specialty mental health follow-up, as 2,875 [89.9% of those connected to VHA] used mental health services and 563 [17.6%] received a high risk for suicide flag.
- Include broader lethal-risk counseling after separation, not only suicide-specific planning, because among 2,283 deaths in the first 2 years after separation, 914 [40.0%] were due to suicide and 718 [31.4%] were due to accidents.
