Predictors of non-fatal suicide attempts and alignment with clinician assessments of overall risk: Findings from veterans' comprehensive suicide risk evaluations.

Saulnier KG, Bagge CL, Ganoczy D, Bahraini NH, Jagusch J, Hosanagar A, Ilgen MA, Pfeiffer PN. Predictors of non-fatal suicide attempts and alignment with clinician assessments of overall risk: Findings from veterans' comprehensive suicide risk evaluations. Psychiatry Research. 2025 Sep 1; 351:116660, DOI: 10.1016/j.psychres.2025.116660.

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Abstract:

This study examined the structured suicide risk assessment utilized by the Veterans Health Administration (VHA), the Comprehensive Suicide Risk Evaluation (CSRE), as related to non-fatal suicide attempts (NFSAs) and provider-determined risk level. The study included 269,374 CSREs, assessing 43 suicide warning signs, risk factors, and protective factors. CSREs were completed by 153,736 patients (67.3 % completed a single CSRE; M = 50.5, 63.6 % White, 86.3 % male). CSREs were the unit of analysis. Multivariable Cox proportional hazards regression models examined NFSAs in the 30 and 365 days after CSRE administration. Multivariable logistic regression models examined provider-determined 1) high acute risk and 2) high chronic risk levels (vs. low or intermediate). Increased risk for 30-day NFSAs was associated with suicidal ideation (multivariable-adjusted hazard ratio [aHR] = 2.23), non-firearm lethal means access (aHR = 1.31), preparations for a suicide attempt (aHR = 1.32), and history of suicidal behavior (aHR = 1.52), as well as provider-determined intermediate acute risk (vs. low; aHR = 1.39), and high and intermediate chronic risk (vs. low; aHRs = 2.33 and 1.71, respectively). Increased risk for 365-day NFSAs was associated with suicidal ideation (aHR = 1.84), history of suicidal behavior (aHR = 1.61), and firearm access (aHR = 0.77) as well as provider-determined high and intermediate chronic risk (vs. low; aHRs = 2.07 and 1.56, respectively). In adjusted models, 26 CSRE responses were associated with provider-determined high acute risk (vs. low/intermediate) and 19 CSRE responses were associated with provider-determined high chronic risk. Findings highlight risk factors for subsequent NFSAs and areas of misalignment with factors associated with provider-determined risk, suggesting benefit to assisting providers synthesize information obtained from comprehensive risk evaluations.