Suicide Risk Among Military Veterans in the Southwestern United States Before and During the COVID-19 Pandemic

Neal Doran; Jenna Gress-Smith; Pushpa Raja; Jack T Waddell; Luther Davis; Sarah De La Rosa; Vanessa Hurwitz; Kris Kratz; Ryan Louis; Jeanie Moore; Lana Peoples

doi:10.1093/milmed/usac303

Suicide Risk Among Military Veterans in the Southwestern United States Before and During the COVID-19 Pandemic

Mil Med. 2022 Oct 13:usac303. doi: 10.1093/milmed/usac303. Online ahead of print.

Authors

Affiliations

¹ VA San Diego Healthcare System and Department of Psychiatry, University of California, San Diego, CA 92161, USA.
² VA Phoenix Healthcare System, Phoenix, AZ 85012, USA.
³ VA Greater Los Angeles Healthcare System and Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA 90073, USA.
⁴ VA Loma Linda Healthcare System, 112021 Benton Street, Loma Linda, CA 92357, USA.
⁵ VA New Mexico Healthcare System, Albuquerque, NM 87108, USA.
⁶ VA Long Beach Healthcare System, Long Beach, CA 90822, USA.
⁷ Northern Arizona VA Healthcare System, Prescott, AZ 86301, USA.

Abstract

Introduction: Military Veterans have an increased risk of suicide compared to the general population, but less is known about changes in risk with the onset of the COVID-19 pandemic, or whether any changes have been moderated by psychiatric or demographic factors. The primary objective was to test the hypothesis that the likelihood of suicide attempt or death by suicide was stable during the first year of the pandemic versus the preceding year for the full sample. A second objective was to test the hypothesis that, in contrast, risk increased for Veteran subgroups characterized by traditional risk factors (e.g., psychiatric diagnosis).

Materials and methods: We extracted electronic health record data for 771,570 Veterans who received one or more health care visits between March 13, 2019, and March 12, 2021, at eight VA hospitals across the southwestern United States. Primary outcome measures were suicide attempts and deaths by suicide. Predictor variables included psychiatric diagnoses and demographic factors.

Results: Multivariable models indicated that the odds of death by suicide did not change during the first year of the COVID-19 pandemic, while the odds of making a suicide attempt declined. Veterans treated for major depression were at heightened risk for attempting suicide in both years, but the association was smaller during the pandemic than the year prior. In contrast, the relative risk of attempt for Veterans who were never married and Veterans treated for a non-alcohol, non-opioid substance-use disorder increased during the pandemic.

Conclusions and relevance: The findings suggest that the pandemic has not led to an increase in suicidal behavior, which is consistent with other studies, although the degree of decline varied across diagnostic and demographic groups. Further longitudinal research is needed to evaluate whether the prolonged nature of COVID-19 may lead to changes in risk over time.

Grants and funding

n/a/Unfunded