skip to page content
Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website

Risk and Protective Factors Across Socioecological Levels of Risk for Suicide: An Evidence Map

Click for list of published reports
Click for topic nomination form
Click for list of reports in progress

Subscribe to the
ESP Report RSS feed RSS feed icon
Risk and Protective Factors Across Socioecological Levels of Risk for Suicide:  An Evidence Map

Prepared by:
Evidence Synthesis Program (ESP) Center
Minneapolis VA Health Care System
Minneapolis, MN
Timothy J. Wilt, MD, MPH, Director

Recommended citation:
Ullman K, Landsteiner A, Linskens E, MacDonald R, McKenzie L, Murdoch M, Sayer N, Stroebel B, Sultan S, Venables N, Wilt TJ. Risk and protective factors across socioecological levels of risk for suicide: an evidence map. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-009; 2021.



Download PDF: Complete Report, Executive Summary, Report, Appendices

Takeaway

Most studied risk factors for suicide attempts and deaths in general populations of US Veterans or Active Duty Military personnel were at the individual or relationship level of the Socio-Ecological Model. Prior suicide ideation or attempts, depression/anxiety, and substance use were consistently associated with attempts or suicide. Community level factors were less studied. No studies evaluated societal-level factors. Evidence was extensive but most studies were categorized high risk of bias. Higher quality studies are needed.

Context

Suicide remains a critical public health concern, as US suicide rates increased by 33% from 1999 to 2019. Adjusted suicide rates among US Veterans are 1.5 times the general population. VA Health Services Research and Development commissioned this review to develop research priorities and inform research funding. We prepared an evidence map of risk and protective factors in general populations of US Veterans and active duty military identified since 2011 using the socio-ecological suicide model.

Key Findings

Among general populations of Veterans or Active Duty Military populations, not known to be at increased risk of suicide, information from prospective cohort and low risk of bias studies suggested a history of prior suicide ideation or attempts, depression/anxiety, and substance, alcohol, or tobacco use are consistently predictive of, or associated with, suicide attempts and suicide. PTSD was not consistently associated with suicide. Most information was related to individual risk factors and no studies reported on societal level risk or protective factors. We urge caution in interpretation and application of our findings. Most results came from moderate risk of bias retrospective cohort studies. Overall evidence certainty was limited, due in part to study design, variation across studies in risk factor definitions and categorization, uncertainty in models and variables used to assess the independent effect of reported factors and the lack of predictor reporting.

See also

Risk and Protective Factors across Socioecological Levels of Risk for Suicide: An Evidence Map (Management eBrief)


Questions about the HSR website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.