Suicide Risk and Veterans Health Administration Utilization Among those With a Documented Suicide Attempt in the US...

Objective: To examine how Veterans Health Administration (VHA) utilization and suicide outcomes differ for those with and without a suicide attempt prior to separating from the military.

Background: Suicide attempts are frequently described as an important risk factor for future suicide behaviors. Additionally, Veterans who have recently transitioned out of military service have been identified as an at-risk group. We evaluated whether a suicide attempt prior to transition out of military service is an important risk factor among US Veterans.

Methods: This retrospective study included 1,030,599 service members who separated from the active US military from 2015 to 2020. VHA utilization, VHA documented suicide behaviors, suicide mortality, and all-cause mortality in the 2 years following separation were examined, comparing those with and without a documented suicide attempt in their last 2 years of active duty service.

Results: Service members with a documented suicide attempt prior to military separation were significantly more likely to initiate VHA care (hazard ratio [HR]=1.91 [95% CI, 1.84-1.98]) and VHA mental health care (HR =2.20 [95% CI, 2.13-2.28]) compared with those without an attempt. Among those who initiated VHA care, 90% of those with a recent military suicide attempt accessed VHA mental health services. Still, 39% of those with a suicide attempt prior to separation did not utilize VHA care. Those with a history of suicide attempt prior to transition were also more likely to have a suicide attempt (relative risk=7.78 [95% CI, 7.10-8.52]) or die from suicide (standardized mortality ratio= 9.94 [95% CI, 7.37-13.10]) after separation than those without.

Conclusions: Results indicate that most Veterans in this group receive VHA services after separation, but a significant minority of high-risk Veterans remain unengaged.