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

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.

Risk of Suicide Attempts and Self-Directed Violence after SARS-CoV-2 Infection: Outcomes from an Emulated Trial of a Nationwide Observational Matched Cohort of US Veterans

“…It is possible that the overall lower reported rates of suicide attempts and self-directed violence during the pandemic was the result of care disruption and limited access to routine health visits that provide an opportunity to uncover these events. [43][44][45][46] The rates of suicide attempts in a regional study among Veterans at eight VHA facilities in the Southwestern US 47 that examined trends during the first year of the pandemic (March 13, 2020-March 12, 2021) compared to the prior year produced results similar to ours by showing a decline in suicide attempts, but only overall results were reported without stratification by whether COVID-19 occurred. Collectively, our results highlight the importance of suicide prevention efforts during the pandemic, particularly among those infected with SARS-CoV-2 and beginning early after infection.…”

The use of crisis line services during the COVID-19 pandemic: Evidence from the veterans health administration

“…Contrary to these hypotheses, recent literature suggests that the pandemic did not lead to an increase in suicidal behavior in Veterans, nor did it lead to an increase in overall VCL call volume [ [2] , [3] , [4] ]. However, there is limited knowledge about whether geographic differences in COVID-19 burden affected the number of unique Veterans who contacted VCL, and whether the pandemic caused a shift in the type of Veterans contacting the crisis line.…”