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Health Services Research & Development

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2023 HSR&D/QUERI National Conference Abstract

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1111 — Association Between Use of Services to Address Adverse Social Determinants of Health and Suicide Attempt among Veterans

Lead/Presenter: Ann Elizabeth Montgomery,  Birmingham VA Health Care System
All Authors: Montgomery AE (Birmingham VA Health Care System), DeRussy A (Birmingham VA Health Care System) Richman JS (Birmingham VA Health Care System) True G (Southeast Louisiana Veterans Health Care System Blosnich JR (VA Pittsburgh Health Care System)

Objectives:
Adverse social determinants of health (SDH) such as housing instability, unemployment, and justice involvement are associated with suicide-related outcomes among Veterans. A preliminary study of Veterans who screened positive for housing instability found that accessing Veterans Health Administration (VHA) Homeless Programs was associated with reduced all-cause and suicide mortality. The present study explores whether addressing Veterans’ adverse SDH is associated with a reduction in the risk of suicide attempt, with the objective of addressing suicide risk more upstream.

Methods:
For 3 separate cohorts of Veterans with indicators of adverse SDH—housing instability (n = 659,987), unemployment (n = 346,556), and justice involvement (n = 200,487)—we constructed models to assess whether participation in services tailored specifically to address the indicated SDH was associated with a reduction in risk of suicide attempt within 6 months.

Results:
The housing instability cohort had 14.6 non-fatal suicide attempts per 1,000 person years; Veterans who accessed VHA Homeless Programs had a 20–33% increase in the odds of suicide attempt during the 6 months post-identification into the cohort. The unemployment cohort had 18.8 non-fatal suicide attempts per 1,000 person years; Veterans who accessed employment programs had a 11–13% increase in the odds of suicide attempt during the 6 months post-identification into the cohort. The justice involvement cohort had 21.6 non-fatal suicide attempts per 1,000 person years; Veterans who accessed VHA Justice Programs had a 19–35% increase in the odds of suicide attempt during the 6 months post-identification into the cohort. Across all 3 cohorts, prior suicidal ideation and suicide attempt increased risk of suicide attempt as did high levels of involvement in mental health outpatient care.

Implications:
Suicide attempt is a complex outcome, data for which are more likely to be captured among Veterans who are actively engaged in services, which may explain increased odds of suicide attempt among the service users studied here. Qualitative interviews with both Veterans and providers will further elucidate this association.

Impacts:
Preliminary results indicate some potential intervention points for Veterans with a history of suicidal ideation or suicide attempt who also have indicators of adverse SDH.