Suicide Attempts by Gender Among Veterans Experiencing Housing Instability

In the United States, the suicide death rate for military veterans is higher than the rate for the general population. Several risk factors of suicide (e.g., housing instability) occur at elevated prevalence among veterans, and gender is a well-documented moderator of suicide. The objective of the present study was to parse factors risk for suicide attempts at the intersection of gender and housing instability among veterans.

Data were from Veterans Health Administration electronic health records (EHR) from 2013 to 2017 for veterans with indicators of housing instability (n = 659,987). Because EHR did not include gender identity data, gender was defined by sex recorded in the EHR (male or female) and transgender and gender diverse (TGD) status using ICD-10 diagnosis codes related to gender dysphoria. A discrete-time survival analysis was used, with person-month as the unit of analysis, to examine correlates of suicide attempt over time within each gender group (i.e., cisgender men, cisgender women, or TGD).

TGD veterans had 2 × to 3 × greater prevalence of suicide attempt than cisgender men and women veterans. Suicide attempt during follow-up was lower than suicide attempt at baseline for both cisgender men veterans and TGD veterans, however, for cisgender women veterans, suicide attempt during follow-up was greater than at baseline. Both baseline and recent suicidal ideation were strong predictors of suicide attempt during follow-up across all 3 gender groups. Utilization of social services was positively related to suicide attempt for cisgender males.

Among a population of veterans with high risk for suicide (i.e., experienced housing instability), TGD veterans had the greatest prevalence of suicide attempt. Future studies are needed to determine how VA suicide prevention efforts reach TGD veterans. Social service programs may indicate acute risk, particularly cisgender men, and may benefit from greater synergy with suicide prevention efforts.