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2023 HSR&D/QUERI National Conference Abstract

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4124 — A Paucity of Data on Veterans 65 and Older and Risk of Suicide: A Systematic Review

Lead/Presenter: Jennifer Sullivan,  COIN - Providence
All Authors: Sullivan JL (LTSS COIN), Simons, K (Canandaigua VA Medical Center) Mills, W (VA Providence Healthcare System, LTSS COIN) Hilgeman, M (Tuscaloosa VA Medical Center) Freytes, I (Center of Innovation on Disability & Rehab Research (CINDRR)) Morin, R (Hoag Memorial Hospital Presbyterian) Bower, E (Pacific University, University of Rochester) Clark, R (San Francisco VA Health Care System, UCSF) Byers, A (San Francisco VA Health Care System, UCSF)

Objectives:
The Veterans Health Administration (VA) serves a higher proportion of geriatric patients compared to other healthcare systems in the United States. The Veteran population is aging with the highest counts of death by suicide in older Veterans (~70% of Veteran suicide deaths are in Veterans 50 years and older). However, it remains unclear from the extant literature what factors may influence increased or decreased risk of late-life suicide in veterans. To effectively target suicide prevention interventions, it is important to understand clinically identifiable risk factors. The objective of this systematic review was to identify risk and protective factors related to suicide outcomes among older Veterans. Furthermore, it offers benchmark data regarding future study directions and hypothesis generation for late-life suicide research and for informing potential intervention and prevention efforts in this area.

Methods:
We searched PubMed, Web of Science, EMBASE, and PsycInfo over all time points up to July 1, 2021. A combined initial set of 2,258 abstracts were identified and 1,658 abstracts were screened for inclusion. Results were reviewed to establish consensus for papers requiring full text review (n = 459).

Results:
The final sample was composed of 19 studies published between 2006-2022. We found five domains of explanatory factors studied (i.e., neuropsychiatric, social determinants of health, aging stereotypes, residential and supportive housing settings, and multi-factorial – neuropsychiatric/mental health and physical health) with more risk factors than protective factors reported. Across the three suicide outcomes (death by suicide, nonfatal suicide attempt, and Suicide Ideation), only neuropsychiatric factors were consistently identified as risk factors. Neuropsychiatric factors also comprised the largest group of risk factors studied.

Implications:
Older veterans are vastly underrepresented in studies that shape national suicide prevention strategies. This is of great concern because factors that impact younger veterans may not be as robust in later life.

Impacts:
More innovative targets to consider for intervention and more innovative methods to predict suicide in late-life are needed. There is also continued necessity to design suicide prevention interventions for older veterans given lethality trends.