Longitudinal Risk for Suicidal Self-Directed Violence Among Veterans With Cancer

Area of Science:

• Oncology
• Psychiatry
• Veterans Health

Background:

• Patients with cancer have higher rates of suicidal self-directed violence (SSDV) than the general population.
• Understanding longitudinal risks and risk factors for SSDV among veterans with cancer is critical for improving screening and prevention.

Purpose of the Study:

• To assess longitudinal risks and methods for SSDV among veterans with cancer.
• To identify associated risk factors for SSDV to enhance screening and prevention strategies.

Main Methods:

• A national cohort study of veterans diagnosed with invasive solid or hematologic cancer between January 2014 and December 2023.
• Data were sourced from oncology and suicide registries and the Veterans Health Administration (VA).
• Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for SSDV risk factors.

Main Results:

• The study identified 2400 SSDV events (1%) among 292,271 veterans, with poisoning being the most common method (26%).
• Elevated SSDV probabilities were observed in veterans with specific cancers (CNS, pancreas, head and neck, liver, thyroid), severe frailty, advanced cancer, chronic mental illness, and high pain scores.
• Increased SSDV hazards were noted for Asian veterans, unmarried veterans, and those with CNS or head and neck cancers compared to White veterans and those with lung cancer, respectively. Risk remained elevated for younger, unmarried, and certain cancer subgroups even five years post-diagnosis.

Conclusions:

• Veterans with cancer are at significant risk for SSDV that can persist for years after diagnosis.
• Subgroups such as younger veterans, Asian veterans, and those with thyroid cancer represent previously overlooked high-risk populations.
• Systematic tracking of all suicidal behaviors, not solely fatal attempts, is essential for developing tailored screening and prevention strategies within cancer care.