Veterans Justice Programs: Assessing Population Risks for Suicide Deaths and Attempts

Abstract

Objectives Understanding suicide risks among Veteran subpopulations is a national priority. This study assessed risks of suicide, suicide attempts, and other‐cause mortality among recipients of Veterans Health Administration (VHA) Veterans Justice Program services as compared to other Veteran VHA users. Methods Per VHA records, the cohort included 5,401,192 Veterans alive as of January 1, 2013 and with VHA utilization in 2012. Receipt of Veterans Justice Outreach (VJO) or Health Care for Reentry Veterans (HCRV) services in 2012 was assessed using encounter codes. Multivariable proportional hazards regression assessed risks of suicide (per National Death Index search results from the VA/DoD Mortality Data Repository) and attempts (per diagnoses and site reports) in 2013–2016, adjusting for demographic and clinical indicators. Results Compared to other patients, Veterans with VJO encounters had greater risk of suicide (unadjusted HR = 2.80, 95% confidence interval [CI] = 2.30–3.40; adjusted HR = 1.25, 95% CI = 1.02–1.53) and attempts (unadjusted HR = 8.88, 95% CI = 8.45–9.35; adjusted HR = 1.06, 95% CI = 1.00–1.11). Veterans with HCRV encounters had elevated risk of suicide attempts (unadjusted HR = 4.56, 95% CI = 4.00–5.20; adjusted HR = 1.42, 95% CI = 1.24–1.62). Risks were also elevated for other external causes of mortality. Conclusions Findings document increased risk of suicidal behavior among Veterans Justice Program recipients. These results have informed VHA suicide prevention activities.

Associations between justice involvement and PTSD and depressive symptoms, suicidal ideation, and suicide attempt among post-9/11 veterans.

“…Building upon prior work (Blodgett et al, 2015;Holliday et al, 2020;Palframan al., 2020;Taylor et al, 2020), this study underscores that justice-involved veterans are an at-risk, vulnerable population with elevated mental health symptoms and suicidal ideation severity. This is among the first studies to examine whether veterans with and without a lifetime history of justice involvement differ regarding the severity and presence of various mental health sequelae, including depression and suicidal ideation.…”

“…To better understand factors associated with justice involvement in the veteran population, addressing the limitations of prior studies is essential. As previously noted, a limitation of prior work examining mental health and suicide risk among justice-involved veterans is that these studies have largely focused on those using VHA services (e.g., Palframan et al, 2020). However, a significant number of justice-involved veterans do not qualify for VHA care (Bronson et al, 2015).…”

“…Yet research examining this association remains fairly limited. Palframan and colleagues (2020) examined whether rates of suicidal self-directed violence differed between veterans accessing and not accessing Health Care for Reentry Veterans (HCRV) and Veterans Justice Outreach (VJO) programming, which are VHA services for justice-involved veterans. After adjusting for a number of correlates of suicide risk, veterans accessing HCRV services were more likely to attempt suicide (HR: 1.42 [1.24, 1.62 95% CI]), while those accessing VJO services were more likely to die by suicide (HR: 1.25 [1.02, 1.53 95% CI]), compared to veterans not accessing these services.…”

Criminal legal involvement among recently separated veterans: Findings from the LIMBIC study.

“…Following other studies of criminal legal involvement of veterans (Finlay et al, 2016; Palframan et al, 2020; Tsai et al, 2017), we constructed the dependent variable by coding VHA-documented criminal legal involvement in one of two programs: (a) Veterans Justice Outreach (a program that identifies veterans involved in the criminal justice system in order to facilitate their access to VA services at the earliest possible point in the criminal legal process) and (b) Health Care for Reentry Veterans (a program that identifies veterans in jail or prison who will reenter the community and connects them with services to prevent homelessness after incarceration). Medical documentation of VHA clinic code for either program denotes a substantiated instance of criminal legal involvement.…”

“…A third approach uses Department of Veterans Affairs’ (VA) medical records documenting that a veteran received justice program services (Finlay et al, 2016; Palframan et al, 2020; Tsai et al, 2017). This assessment method parallels that used in studies of other veteran psychosocial functioning outcomes (e.g., homelessness).…”