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Suicide risk was nearly 10 times higher in the 2 years after separation for Veterans who had a documented suicide attempt in the last 2 years of active duty compared with those without that history. The study found a suicide standardized mortality ratio of 9.9 (95% CI, 7.4–13.1) after adjusting for age, sex, service branch, and education level. All-cause mortality was also higher in this group, with an SMR of 5.5 (95% CI, 4.2–7.1).

In the first 2 years after separation, 60.7% of those with a documented active duty suicide attempt used any VHA services, compared with 46.0% of those without a recent attempt. In raw numbers, that was 3,199 of 5,274 recent-attempt Veterans versus 472,002 of those without a documented attempt. The authors also reported that this group engaged with VHA services sooner after separation.

Among Veterans with a recent active duty suicide attempt who connected to VHA, 89.9% received mental health care in the first 2 years after separation. This was substantially higher than the 58.0% seen in VHA users without a recent active duty suicide attempt. The study found the same general pattern across inpatient mental health services, outpatient mental health services, and emergency department use.

Among Veterans who used VHA care after separation, 14.3% of those with a recent active duty suicide attempt had at least 1 documented postseparation suicide attempt, compared with 1.4% of those without that history. After adjustment for age, sex, service branch, and education level, the relative risk was 7.78 (95% CI, 7.10–8.52). This indicates that a documented suicide attempt shortly before leaving military service marked a very high-risk subgroup for recurrent suicidal behavior after transition.

Yes. Among Veterans who used VHA care after separation, 17.6% of those with a recent active duty suicide attempt had a high risk for suicide flag in the VHA electronic health record, compared with 1.6% of those without a recent active duty attempt. In raw numbers, that was 563 versus 7,528 individuals, respectively.

Suicide was the leading cause of death in the first 2 years after separation, accounting for 914 of 2,283 deaths (40.0%). Accidents were the second most common cause, accounting for 718 deaths (31.4%). Among accidental deaths, 49.2% involved motor vehicles and 39.4% were due to accidental poisonings, including drug overdoses.

A documented suicide attempt in the last 2 years of active duty was uncommon, occurring in 5,274 of 1,030,599 separating service members (0.5%). The most recent pre-separation attempt occurred a mean of 244 days before separation (SD = 178 days). The most common method was poisoning or overdose (60.7%), followed by suffocation (13.5%) and cutting or piercing (13.0%).

This was a retrospective cohort evaluation of 1,030,599 individuals who separated from the Active component of the Air Force, Army, Marine Corps, or Navy between January 1, 2015, and December 31, 2020. The investigators compared those with and without a documented suicide attempt in the 2 years before separation and followed outcomes for 2 years after separation. Outcomes included VHA use, mental health care use, documented postseparation suicide attempts among VHA users, suicide mortality, and all-cause mortality.

The authors noted several important limitations. Suicide attempts before and after separation may have been underestimated because ascertainment relied largely on medical surveillance systems. The cohort included only Active component service members, so results may not generalize to Reservists. Among those with an active duty suicide attempt, the number of deaths in the first 2 years after separation was relatively small (n=62), which may make mortality estimates unstable. Some analyses, including postseparation suicide attempts, were limited to Veterans who used VHA care, so findings may differ for Veterans who did not use VHA.