Social Stressors Strongly Associated with Suicide Ideation and Attempt among Veterans

April 3, 2020

Takeaway: Social stressors (such as experiences of violence, housing instability, employment or financial problems, legal problems, social/family problems, lack of transportation) are strongly related to suicide ideation and attempts even after accounting for psychiatric conditions, and the odds increase when more than one social stressor is involved. Documenting social stressors in VA electronic health records (EHR) and monitoring could improve suicide prevention efforts.

VA addresses some social stressors by screening all Veterans in VA care (e.g., for homelessness and military sexual trauma) and offering services to address related needs (e.g., vocational rehabilitation and supportive housing). However, there is scarce research on how a wider array of social stressors may be identified within Veterans’ electronic health record (EHR), and how they might contribute to outcomes such as suicidal ideation or suicide attempt. This study examined documented social stressors in VA’s EHR and how these stressors were associated with suicidal ideation and suicide attempt among 293,872 Veterans. Investigators assessed seven types of social stressors: 1) experiences of violence, 2) housing instability, 3) employment or financial problems, 4) legal problems, 5) social or familial problems, 6) lack of access to care or transportation, and 7) non-specific psychological needs. Findings show:

• Overall, 16% of patients had at least one (past or present) social stressor noted in their EHR during 2016. Those events were strongly related to suicidal ideation and suicide attempt. Having more than one stressor increased the odds of suicidal ideation by 67% per stressor and suicide attempt by 49%.

Further research should explore if VA’s suicide prevention efforts could be improved by addressing social stress factors in conjunction with current mental health treatment efforts.

CITATION: Blosnich J, Montgomery A, Dichter M, et al. Social Determinants and Military Veterans’ Suicide Ideation and Attempt: A Cross-Sectional Analysis of Electronic Health Record Data. Journal of General Internal Medicine. November 19, 2019; Epub ahead of print.