Prevalence and Trends in Suicidal Behavior Among US Military Veterans During the COVID-19 Pandemic

Abstract

IMPORTANCEThe COVID-19 pandemic has raised considerable concerns about increased risk for suicidal behavior among US military veterans, who already had elevated rates of suicide before the pandemic.OBJECTIVE To examine longitudinal changes in suicidal behavior from before the COVID-19 pandemic to nearly 10 months into the pandemic and identify risk factors and COVID-related variables associated with new-onset suicide ideation (SI). DESIGN, SETTING, AND PARTICIPANTS This population-based prospective cohort study used data from the first and second wave of the National Health and Resilience in Veterans Study, conducted from November 18, 2019, to December 19, 2020. Median dates of data collection for the prepandemic and peripandemic assessments were November 21, 2019, and November 14, 2020, nearly 10 months after the start of the COVID-19 public health emergency in the US. A total of 3078 US military veterans aged 22 to 99 years were included in the study. MAIN OUTCOMES AND MEASURES Past-year SI and suicide attempts. RESULTS In this cohort study of 3078 US veterans (mean [SD] age, 63.2 [14.7] years; 91.6% men; 79.3% non-Hispanic White veterans, 10.3% non-Hispanic Black veterans, and 6.0% Hispanic veterans), 233 (7.8%) reported past-year SI, and 8 (0.3%) reported suicide attempts at the peripandemic assessment. Past-year SI decreased from 10.6% prepandemic (95% CI, 9.6%-11.8%) to 7.8% peripandemic (95% CI, 6.9%-8.8%). A total of 82 veterans (2.6%) developed new-onset SI over the follow-up period. After adjusting for sociodemographic and military characteristics, the strongest risk factors and COVID-19-related variables for new-onset SI were low social support (odds ratio [OR], 2.77; 95% CI, 1.46-5.28), suicide attempt history (OR, 6.31; 95% CI, 2.71-14.67), lifetime posttraumatic stress disorder and/or depression (OR, 2.25; 95% CI, 1.16-4.35), past-year alcohol use disorder severity (OR, 1.06; 95% CI, 1.01-1.12), COVID-19 infection (OR, 2.41; 95% CI, 1.41-5.01), and worsening of social relationships during the pandemic (OR, 1.47; 95% CI, 1.16-1.88). CONCLUSIONS AND RELEVANCEThe results of this cohort study suggest that despite grim forecasts that the COVID-19 pandemic would exacerbate suicidality among US military veterans, the rate of SI decreased at the population level nearly 10 months into the pandemic. Veterans who were infected with COVID-19 were more than twice as likely to report SI, which suggests the need for future research to examine the potential link between COVID-19 infection and suicidal behavior.

Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel

“…Results of this study further indicated that prepandemic loneliness and pandemic-related social stressors were associated with an increase in psychological distress [ 15 ]. Although suicide among veterans over the course of the pandemic did not increase, low social support and worsening of social relationships were among the risk factors present for veterans who did develop new-onset suicide ideation during the pandemic [ 16 ]. Additionally, at the beginning of the pandemic, it was hypothesized that there might be a mental health crisis among older adults due in part to complications from the difficulty in adopting technologies useful during quarantine (eg, software to facilitate telehealth visits or stay connected with loved ones) and lack of contact with friends, family, and caregivers [ 8 ].…”

The global impact on mental health almost 2 years into the COVID-19 pandemic

“…Measuring the impact of COVID-19 on population mental health poses significant challenges (Patten et al 2021). While numerous studies have reported increase in psychiatric morbidity since onset of COVID-19, in particular for population levels of depression and anxiety (COVID-19 Mental Disorders Collaborators, 2021;Thorisdottir et al 2021;Santabárbara et al 2021;Fancourt et al 2021;Pierce et al 2020;Samji et al 2021), some studies have also suggested the possibility that the overall effect on population mental health was moderate (Hafstad et al 2021;Sharp et al 2021;Knudsen et al 2021;Nichter et al 2021;John et al 2020). Several of these studies suggest greater mental health issues among those diagnosed with COVID-19 and perhaps among certain population cohorts such as the youth population.…”

PTSD Symptoms and Coping with COVID-19 Pandemic among Treatment-Seeking Veterans: Prospective Cohort Study

“…Patients with pre-existing mental disorders appeared to be at higher risk for wide-ranging mental health effects [ 5 , 6 , 7 ]. Regarding the veteran population, the results from recent studies revealed resilience to mental health problems and lower rates of suicidal ideation among US military veterans nearly 10 months into the pandemic [ 8 , 9 ]. However, these studies also showed that the prevalence of generalized anxiety disorder increased and the prevalence of major depressive disorder and post-traumatic stress disorder (PTSD) remained stable during the pandemic [ 10 ].…”