Examination of increasing suicide rates among rural Hispanic VA patients

Death by suicide is increasing more rapidly among Hispanics than non-Hispanics who use United States Department of Veterans Affairs (VA) health services, and the increase is most rapid among those living in rural areas. Our goal was to identify characteristics of rural Hispanic VA patients that contribute to this emerging disparity.

We linked electronic medical records from the VA, personnel data from the US Department of Defense, mortality data from the US National Death Index, and data on area characteristics from the US Census Bureau to examine suicide trends among Hispanic VA patients from 2005 through 2019. After identifying the strongest predictors of suicide in the rural and urban Hispanic populations, we examined how those characteristics changed over time.

Age and sex-adjusted suicide mortality rates were consistently higher for rural versus urban Hispanic patients beginning in 2012, with the most recent rolling 5-year average rates being 31.0 per 100,000 for rural compared to 20.3 per 100,000 for urban in 2019. Models to predict suicide had fair performance in the rural (accuracy = 0.62, 95% CI: 0.51, 0.73) and urban (accuracy = 0.67, 95% CI: 0.63, 0.70) groups. Mental health diagnoses were predictive of suicide among rural Hispanic patients, but there was no evidence that mental health diagnoses were increasing more rapidly in rural compared to urban patients.

While we confirmed that there is a higher rate of death by suicide among rural Hispanic VA patients relative to their urban counterparts, we were unable to identify clear drivers of this finding.