Veterans with COVID-19 Have Elevated Rates of Suicide Attempt and Other Self-Directed Violence
BACKGROUND:
COVID-19’s negative effects on mental health are increasingly evident, but its impact on suicide-related outcomes is poorly understood, especially among populations at elevated risk, such as Veterans. In this study, researchers used electronic health record data to examine associations between suicide attempt and other self-directed violence (SDV) and time since COVID-19 infection in 198,938 VA patients who were infected between March 1, 2020, and March 31, 2021, and 992,036 similar but uninfected VA patients. Three time periods were reviewed following the date of infection: days 1-30, 31-365, and 1-365, through March 31, 2022. Analyses included results for sex, race, and age subgroups.
FINDINGS:
- Veterans infected with COVID-19 had a 41% higher risk of a suicide attempt and 38% higher risk of other SDV compared to members of the uninfected cohort for at least one year following infection.
- Suicide attempt and SDV rates were higher in the COVID-19 group than in the uninfected group during all of the reviewed time periods, with the highest rates occurring in the first 30 days following the date of infection.
- Among the infected and uninfected cohorts, rates of suicide attempts and other SDV were substantially lower than those reported during the two years prior to the pandemic, possibly indicating that care disruption and limited care access during the pandemic reduced the opportunity to report these events.
IMPLICATIONS:
- Results support suicide risk screening of those infected with COVID-19 to identify opportunities to prevent self-harm.
- While the risks of suicide attempt and other SDV were greatest during the first 30 days after infection, the elevated risk persisted over the year.
- Increased risk varied across subgroups, highlighting the importance of considering characteristics such as age, sex, race, ethnicity, and those with history of suicide attempts or other SDV.
LIMITATIONS:
- Researchers cannot rule out outcome ascertainment bias related to increased access to healthcare among COVID-19 infected patients.
- Lack of cause of death data prevented inclusion of suicide deaths as a separate outcome.
- Identification of specific mechanisms (e.g., increased isolation, loss of functioning) of suicide risk following COVID-19 infection was not possible based on available data.
- Some misclassification of infected Veterans is likely, particularly with home testing and patients who did not know they were infected.
- The study did not control for confounders associated with suicide, including psychological distress, ideation, loss of employment, substance use, or other factors.
AUTHOR/FUNDING INFORMATION:
This study was supported by HSR&D’s VA COVID-19 Observational Research Collaboratory (CORC), studies C19 21-278 & 279. Dr. Hynes was supported in part by a Senior Research Career Scientist Award; Dr. Chen was supported by a Career Development Award. Drs. Hynes, Niederhausen, and Chen are part of HSR&D’s Center to Improve Veteran Involvement in Care.
Hynes DM, Niederhausen M, Chen JI, et al. for the VA COVID-19 Observational Research Collaboratory (CORC). Risk of Suicide-Related Outcomes after SARS-COV-2 Infection: Results from a Nationwide Observational Matched Cohort of U.S. Veterans. Journal of General Internal Medicine. October 26, 2023;online ahead of print.
