Veterans at High Risk for Post-COVID-19 Suicide Attempts or Other Self-Directed Violence.

Bui DP, Niederhausen M, Hickok AW, Govier DJ, Rowneki M, Naylor JC, Hawkins E, Boyko EJ, Iwashyna TJ, Viglianti EM, Ioannou GN, Chen JI, Hynes DM. Veterans at High Risk for Post-COVID-19 Suicide Attempts or Other Self-Directed Violence. JAMA Network Open. 2025 Mar 3; 8(3):e250061, DOI: 10.1001/jamanetworkopen.2025.0061.

Related HSR&D Project(s)

• C19 21-279 – COVID-19 Observational Research Collaboratory - Long-Term Outcomes (LTO) Study

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Abstract:

IMPORTANCE: US veterans have a higher risk of suicide than the general civilian population. Research suggests that COVID-19 infection is associated with increased risk of suicide attempts or other forms of self-directed violence (SDV) among veterans. OBJECTIVE: To identify subgroups of veterans with high risk of post-COVID-19 suicide attempts or SDV. DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective cohort study conducted using data from the Veteran Health Administration (VHA). Participants included VHA enrollees with a first case of COVID-19 between May 1, 2021, and April 30, 2022, residing in the 50 states or Washington, DC. EXPOSURE: COVID-19 infection. MAIN OUTCOMES AND MEASURES: The main outcome was a suicide attempt or SDV 12 months after COVID-19 infection. Latent class analysis was used to identify subgroups. Outcome rates and 95% CIs per 10?000 veterans were calculated. Multinomial regressions were used to model outcome risk and marginal risk ratios with 99.5% CIs to compare outcome risk across latent classes. RESULTS: The cohort included 285?235 veterans with COVID-19 and was predominantly male (248?118 veterans [87.0%]) and younger than 65 years (171?636 veterans [60.2%]). Chronic pain (152?788 veterans [53.6%]), depression (98?093 veterans [34.4%]), and posttraumatic stress disorder (79?462 veterans [27.9%]) diagnoses were common. The 12-month outcome rate was 73.8 events per 10?000 (95% CI, 70.7-77.0 events per 10?000). Two latent classes with high rates of suicide attempt or SDV were identified. The first high-risk subgroup (46?693 veterans [16.4%]) was older (34?472 veterans [73.8%]?aged = 65 years) and had a high prevalence of physical conditions (43?329 veterans [92.8%] had hypertension, and 36?824 veterans [78.9%] had chronic pain); the 12-month outcome rate was 103.7 events per 10?000 (95% CI, 94.7-113.3 events per 10?000). The second high-risk subgroup (82?309 veterans [28.9%]) was generally younger (68?822 veterans [83.6%]?aged < 65 years) with a lower prevalence of physical conditions but high prevalence of mental health conditions (61?367 veterans [74.6%] had depression, and 50?073 veterans [60.8%] had posttraumatic stress disorder); the 12-month outcome rate was 162.9 events per 10?000 (95% CI, 154.5-171.8 events per 10?000), and compared with the lowest risk subgroup, the 12-month risk of suicide attempts or SDV was 14 times higher in this subgroup (risk ratio, 14.23; 99.5% CI, 10.22-19.80). CONCLUSIONS AND RELEVANCE: In this cohort study of veterans with COVID-19, 2 veteran subgroups with distinct health profiles had high rates of suicide attempts and SDV, suggesting that different groups may require different approaches to suicide prevention after COVID-19.