Significantly Higher Rates of Suicide among Sexual Minority Veterans Compared to Other Veterans and the General Public

BACKGROUND:
Suicide is a widespread public health concern and remains a priority for VA, where, in 2017, the suicide rate among Veterans was 1.5 times higher than the non-Veteran US population. However, as in any population, the Veteran community is heterogeneous, and suicide disproportionally burdens certain groups. For example, suicide rates are higher among male Veterans compared to female Veterans. People with gay, lesbian, or bisexual sexual orientations (i.e., sexual minority) also have a higher prevalence of lifetime suicide attempt, and limited research suggests greater risk of suicide death. This retrospective cohort study assessed suicide mortality among Veterans from October 1, 1999 through September 30, 2017 who had documentation of sexual minority sexual orientation status recorded in VA’s electronic health record (EHR). Investigators identified 8.1 million Veterans – of which, 96,893 (68% male, 70% White) had at least one sexual minority documentation in the EHR. National Death Index (NDI) data were used to calculate death rates/causes among sexual minority Veterans.

FINDINGS:

• Risk of death from suicide was more than four-fold higher for sexual minority Veterans compared to the general US population – and more than twice as high as what has been found among the general Veteran population.
  • Suicide was the 5^th leading cause of death in 2017 among sexual minority Veterans compared to ranking 10^th among the general US population.
  • The most common method of suicide was by firearm (40%) with men more likely than women (41% vs. 35%, respectively) to use firearms. For both sexual minority men and women, suicide was the most common cause of death among those 18–29 years of age, accounting for approximately 40% of all deaths.
• Though not a focus of this study, there was evidence of excess mortality across every cause of death category among sexual minority Veterans compared with the US population.

IMPLICATIONS:

• Findings suggest that sexual minority Veterans are uniquely affected by suicide mortality. Understanding whether and to what extent prevention efforts reach this vulnerable population should be the focus of future research. Adding self-reported sexual orientation as a standard, voluntary demographic element in EHR would facilitate future research.

LIMITATIONS:

• This study used EHR data to identify sexual minority status and NDI data to define suicide mortality; both have inherent limitations that may have impacted study findings.

AUTHOR/FUNDING INFORMATION:
This study was supported using resources and facilities at HSR&D’s VA Informatics and Computing Infrastructure (VINCI). Drs. Lynch, Schliep, DuVall, Ms. Gatsby, and Messrs. Viernes and Alba are with VINCI in Salt Lake City, UT. Dr. Blosnich is part of HSR&D’s Center for Health Equity, Research and Promotion (CHERP) in Pittsburgh, PA.

Lynch KE, Gatsby E, Viernes B, Schliep K, Whitcomb BW, Alba P, DuVall SL, and Blosnich JR. Evaluation of Suicide Mortality among Sexual Minority US Veterans, 2000-2017. JAMA Network Open. December 28, 2020.