Key Takeaways

From the Authors As published in the article
  1. Transitioning out of the military to civilian life may be stressful for many Veterans, but risks are increased among service members with a suicide attempt shortly before separation.
  2. These Veterans may benefit from suicide prevention services after transition.
  3. Efforts to connect Veterans to Veterans Health Administration services may be helpful since the VA has a comprehensive suicide prevention strategy with unique suicide prevention services.
Extended Takeaways
  1. Only 5,274 (0.5%) of 1,030,599 separating service members had a documented suicide attempt in the last 2 years of active duty, but this subgroup had markedly elevated postseparation risk, supporting targeted transition planning for a relatively small, identifiable population.
  2. Among Veterans who connected to VHA, postseparation suicide attempts were documented in 14.3% of those with a recent active duty attempt versus 1.4% of those without, with an adjusted RR [95% CI]=7.78 [7.10–8.52], indicating that a recent military attempt should be treated as a major warning sign for recurrence after discharge.
  3. The first 2 years after separation carry substantial mortality burden overall: 914 of 2,283 deaths (40.0%) were due to suicide and 718 (31.4%) to accidents, with 49.2% of accidental deaths involving motor vehicles and 39.4% due to accidental poisonings, including drug overdoses.
  4. Within VHA users, high-acuity indicators remained common after separation in the recent-attempt group, including a high risk for suicide flag in 563 [17.6%] versus 7,528 [1.6%], which underscores the need for close monitoring even after initial linkage to care.
  5. Method matters for follow-up risk management: the most recent pre-separation attempt occurred on average 244 days before separation (SD=178 days), and poisoning or overdose accounted for 60.7% of attempts, far more often than suffocation (13.5%) or cutting or piercing (13.0%).
  6. Mortality analyses showed that recent attempters had substantially elevated death risk after leaving service, with suicide SMR 9.9; 95% CI, 7.4, –13.1 and all-cause mortality SMR 5.5; 95% CI, 4.2–7.1, so postseparation care should address both suicide prevention and broader lethal-risk exposures.
Clinical Pearls

  1. 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]).

  2. 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.

  3. 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.

  4. 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.

  5. 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).

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Physicians Postgraduate Press, Inc. (PPP) makes no warranties about the accuracy or completeness of any information published in The Journal of Clinical Psychiatry or other PPP materials, and disclaims liability for any use or non-use of that information. Clinicians should not rely solely on these materials and should exercise their own professional judgment when making patient care decisions on an individualized basis.

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