Recent trends in the rural–urban suicide disparity among veterans using VA health care

Shiner, Brian; Peltzman, Talya; Cornelius, Sarah; Gui, Jiang; Forehand, Jenna; Watts, Bradley V.

doi:10.1007/s10865-020-00176-9

Cited by 38 publications

(42 citation statements)

References 47 publications

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“…The majority used data of a cross-sectional nature [ 30 , 31 , 32 , 33 , 34 ]. Because the suicide rates were usually based on administrative databases (e.g., death registers) covering the entire population, and given that privacy needed to be guaranteed, ecological designs were often applied [ 35 , 36 ]; other designs were scarce (e.g., cohort design [ 37 ]). The year of publication of the included articles covered the period 1977–2020.…”

Section: Resultsmentioning

confidence: 99%

“…Pesonen et al focused on Finnish males in the 1980s and 1990s, but could not confirm significant geographic inequalities in suicide mortality for eastern Finland (though rates for the countryside were higher) with regionally diverging rates (e.g., a decline in urban areas) [ 38 ]. Congruent with suicide rates (2003–2017) for U.S. Veterans Affairs patients [ 37 ], no significant differences were observable in Australian urban and rural suicide rates (1986–1990) [ 41 ]. Others did not find urban–rural differences [ 30 , 44 , 49 , 51 ].…”

Section: Resultsmentioning

confidence: 99%

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Inequalities of Suicide Mortality across Urban and Rural Areas: A Literature Review

Casant

Helbich

2022

IJERPH

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Suicide mortality is a major contributor to premature death, with geographic variation in suicide rates. Why suicide rates differ across urban and rural areas has not yet been fully established. We conducted a literature review describing the urban–rural disparities in suicide mortality. Articles were searched in five databases (EMBASE, PubMed, PsychINFO, Scopus, and Web of Science) from inception till 26 May 2021. Eligible studies were narratively analyzed in terms of the urban–rural disparities in suicides, different suicide methods, and suicide trends over time. In total, 24 articles were included in our review. Most studies were ecological and cross-sectional evidence tentatively suggests higher suicide rates in rural than in urban areas. Men were more at risk by rurality than women, but suicide is in general more prevalent among men. No obvious urban–rural pattern emerged regarding suicide means or urban–rural changes over time. Potential suicidogenic explanations include social isolation, easier access to lethal means, stigmatization toward people with mental health problems, and reduced supply of mental health services. For research progress, we urge, first, individual-level cohort and case-control studies in different sociocultural settings. Second, both rurality and urbanicity are multifaceted concepts that are inadequately captured by oversimplified typologies and require detailed assessments of the sociophysical residential environment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Inequalities of Suicide Mortality across Urban and Rural Areas: A Literature Review

Casant

Helbich

2022

IJERPH

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“…Physical and mental health comorbidities were assessed in the 2 years prior to date of admission using published bins of related ICD-9 14 and ICD-10 codes. 13 , 16 For mental health comorbidities, we coded the number of Diagnostic and Statistical Manual of Mental Disorders (5th edition) (DSM-5) categories (0–1, 2–3 and ≥4). 17 For physical health comorbidities, we coded diagnoses based on the number of Elixhauser conditions (0, 1, and ≥2).…”

Section: Methodsmentioning

confidence: 99%

“…We determined zip code of residence annually and relied on the Rural-Urban Commuting Area (RUCA) classification scheme to define RUCA codes 1–3 as urban and all others as rural. 16,20 Finally, we separated year of admission into four time periods (2003–2007, 2008–2011, 2012–2015 and 2016–2019) in order to adjust for and evaluate temporal trends.…”

Section: Methodsmentioning

confidence: 99%

Association between suicide, external-cause and all-cause mortality and irregular mental health discharge among the US veteran population

et al. 2021

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Background Irregular hospital discharge is highly prevalent among people admitted to hospital for mental health reasons. No study has examined the relationship between irregular discharge, post-discharge mortality and treatment setting (i.e. mortality after patients are discharged from acute in-patient or residential mental health settings). Aims To understand the relationship between irregular discharge and mortality among patients discharged from acute in-patient and residential settings. Method A retrospective study was conducted in members of the US veteran population discharged from acute in-patient or residential settings of the US Department of Veterans Affairs between 2003 and 2018. Multivariate Cox proportional hazards were used to evaluate associations between irregular discharge and suicide, external-cause (as defined by ICD-10 Codes: V01-Y98) and all-cause mortality in the first 30-, 90- and 180-days post-discharge. Results There were over 1.5 million mental health discharges between 2003 and 2018. Patients with an irregular discharge were at increased risk for suicide, external-cause and all-cause mortality in the first 180 days after discharge. In the first 30 days after discharge, patients with irregular discharge had more than three times greater suicide risk than patients with regular discharge (adjusted hazard ratio (HR) = 3.41, 95% CI 2.21–5.25). Suicide risk was higher among patients with irregular discharge in the first 30 days after acute in-patient discharge (adjusted HR = 1.55, 95% CI 1.11–2.16). In both settings, the mortality risk associated with irregular discharge attenuated but remained elevated within 90 and 180 days. Conclusions Irregular discharge after an acute in-patient or residential stay poses a large risk for mortality soon after discharge. Clinicians must identify effective interventions to mitigate harms associated with irregular discharge in these settings.

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“…From the CDW, we abstracted the following covariates: age, sex, race/ethnicity (Black, non-Black Hispanic, White, other), marital status at time of admission, primary discharge diagnosis, year of admission, and preadmission mental and physical health diagnoses over the 2 years before admission coded using a previously developed index (Shiner et al, 2021). We categorized primary discharge diagnosis using the following groupings: alcohol use disorders, bipolar disorders, depressive disorders, drug use disorders, psychotic disorders, trauma-related disorders, and other mental health disorders.…”

Section: Study Variablesmentioning

confidence: 99%

Is It Time for the Mental Health Field to Consider Unplanned Discharge a Key Metric of Patient Safety?

et al. 2022

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Mental health lacks robust measures to assess patient safety. Unplanned discharge is common in mental health populations and associated with poor outcomes. Clarifying whether unplanned discharge varies across settings may highlight the need to develop measures to reduce harms associated with this event. Unplanned discharge rates were compared across the Department of Veterans Affairs' acute inpatient and residential mental health treatment settings from 2009 to 2019. Logistic regression was used to create facility-level, adjusted unplanned discharge rates stratified by setting. Results were described using central tendency. Among 847,661 acute inpatient discharges, the mean unplanned discharge rate was 3.3% (range, 0%-18%). Among 358,117 residential discharges, the mean unplanned discharge rate was 17.9% (range, 1%-48.3%). Unplanned discharge is a marked problem in mental health, with large variation across treatment settings. Unplanned discharge should be measured as part of patient safety efforts.

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Recent trends in the rural–urban suicide disparity among veterans using VA health care

Cited by 38 publications

References 47 publications

Inequalities of Suicide Mortality across Urban and Rural Areas: A Literature Review

Inequalities of Suicide Mortality across Urban and Rural Areas: A Literature Review

Association between suicide, external-cause and all-cause mortality and irregular mental health discharge among the US veteran population

Is It Time for the Mental Health Field to Consider Unplanned Discharge a Key Metric of Patient Safety?

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