Lethal Suicide Methods in Aging Veterans: Associated Profiles, Trajectories, and Transitions Informing Attempts

Veterans Affairs Med Ctr San Francisco, San Francisco CA

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Abstract

Older Veterans are an important and understudied population for suicide prevention. Adults 65 years and older will be 20% of the US population and 50% of the Veteran population by 2030. It has been documented that the majority of decedents who die by suicide in the Veteran population are Veterans 50 years and older (≥ 69%) and over 40% Veterans 65 years and older. Moreover, older adults, including Veterans, have high rates of premeditated lethal means of suicide method indicating less impulsivity and more opportunity to intervene; thus, studying older Veterans is a high priority for supporting suicide prevention. In the current proposal, our objective is to understand the combination of factors that lead to suicide death for aging Veterans by identifying the short- and long-term typologies that best characterize suicide death among older Veterans and by examining pathways from suicide attempt to mortality. Thus far, our research suggests that there are distinct acute medical and psychiatric profiles and potential trajectories that may influence an older individual’s long- term risk of suicide and employment of lethal means, which further influences policies and strategies for mitigation and prevention. To capture these profiles and trajectories, we will use latent clustering techniques to uniquely characterize (separately by social and clinical characteristics) those who attempt and die by suicide. The current proposed research builds on a productive, ongoing body of suicide research in older Veterans. Our work has informed prognostic factors (e.g., psychoactive medication use), timing and burden of diagnosis (i.e., recent diagnosis of mild cognitive impairment or dementia), and life transitions (i.e., reentry into community from incarceration) associated with increased risk of suicide attempt. Yet, major gaps remain in our understanding of how best to characterize risk for lethality of suicide attempt. Short- and long-term precursors delineated by profiles and trajectories of social risk factors (e.g., housing instability, financial strain, interpersonal violence) may inform suicide risk and lethal means of suicide death (e.g., firearms, drug overdose). We propose in this current application to build on the nationally representative cohort for late-life suicide research formed in the PI’s existing CSR&D Merit Award project (the “Older Veteran Suicide Risk Dataset”, CX001119; PI: Byers) with new questions to determine profiles, trajectories, care transitions, and social and clinical factors contributing to risk of suicide attempt and death by suicide in aging Veterans. This unique cohort comprises all Veterans (~5,000,000) who used VA health care services and were aged 50 years and older in fiscal year 2012-2013, prospectively followed to present with data updated annually. The cohort includes information on demographics, all psychiatric and medical diagnoses, prescription medication use, laboratory measures, and information on all suicide-related outcomes, including date and method of suicide death. In the current longitudinal cohort (2012-2019), we have documented >40,000 suicide attempts, including >13,000 suicide deaths. The Veterans Health Administration is also uniquely positioned to study social factors using electronic health data given rare and relevant extant data sources [e.g., VA Health Factors, USVETS, Geocode data, and VA’s National Homeless Programs (HOMES) data]. The current proposal will identify distinct social and clinical typologies that characterize short-term (Aim 1a) and long-term (Aim 1b) course leading to suicide attempt and death by suicide in older Veterans. Furthermore, this study will evaluate extent to which social and clinical risk factor profiles (developed in Aim 1) are associated with increased likelihood of suicide death, including lethal means (Aim 2), and evaluate the influence of acute and emergent care transitions on the pathway to suicide death (Aim 3). We will investigate differences in typologies for high risk but underrepresented groups (e.g., women Veterans; sexual, gender and racial/ethnic minorities). The findings of the proposed project will deepen our understanding of the course of suicide attempts and death by suicide in aging Veterans, and guide patient-centered decisions within suicide prevention, including lethal means safety.