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Publication Briefs

Study Examines Warning Signs Associated with Suicide among Veterans Receiving VA Healthcare

A review of healthcare contact before suicide indicated that 64% of decedents made contact with healthcare providers within one month of their suicide; however, few studies have examined factors that were associated with immediate or near-term risk. Veterans who receive VA healthcare are at higher risk for suicide than the general population, and studies of decedents who received VA care suggest that 51% to 54% make contact with providers within one month of their suicide. This study sought to identify warning signs for suicide within one week of healthcare contact among Veterans who committed suicide. Using VA chart reviews, investigators identified 381 suicide decedents who received VA healthcare in their last year of life — between 2000 and 2006 in the upper Midwest and upstate New York — and compared warning signs for Veterans who died within one week of healthcare contact to Veterans who died later. Investigators then examined whether the identified warning signs also were risk factors for suicide within one month of contact.


  • Of the 381 Veterans who used VA healthcare in their last year of life, 67 (18%) died by suicide within one week of contact. Among these Veterans, documented suicidal ideation was the strongest predictor of suicide. Psychotic symptoms noted during the last VA healthcare visit also were associated with suicide.
  • Of the 381 Veterans who used VA healthcare in their last year of life, 174 (46%) died within one month of contact. Among these Veterans, the warning signs noted above (suicidal ideation and psychotic symptoms) were also risk factors that predicted suicide within a month of contact.
  • Authors note that assessment of suicidal ideation is critical to identifying Veterans at immediate risk, but that both suicidal ideation and psychotic symptoms may also suggest ongoing risk.


  • Data are based on chart reviews, and information about data validity or completeness is not available.
  • There have been numerous suicide prevention practices instituted within the VA healthcare system since the suicides in this study took place, making it unclear whether these findings would be replicated with a more recent cohort of Veterans.
  • Data on non-VA healthcare were unavailable, and chart reviews did not provide information about all potential risk factors (e.g., symptoms related to personality disorder).

This study was funded through VA. Dr. Ilgen is part of HSR&D's Center for Clinical Management Research and the VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), both in Ann Arbor, MI.

PubMed Logo Britton P, Ilgen M, Rudd M, and Conner K. Warning Signs for Suicide within a Week of Healthcare Contact in Veteran Decedents. Psychiatry Research July 13, 2012;e-pub ahead of print.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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