TABLE 1.
Characteristics of Recent Veteran VHA Patient Suicide Decedents by Facility Identification of Suicide: United States, 2013–2017
| All, No. (Column %) or Mean ± SD | Suicide Identified by Facility | Effect Size | P a | |||
| Yes, No. (Row %) or Mean ± SD | No, No. (Row %) or Mean ± SD | RR | Cohen’s d | |||
| Total no. | 11 148 | 3667 (32.9) | 7481 (67.1) | |||
| Year of death | .001 | |||||
| 2013 | 2110 (18.9) | 618 (29.3) | 1492 (70.7) | 1 (Ref) | ||
| 2014 | 2191 (19.7) | 718 (32.8) | 1473 (67.2) | 1.1 | ||
| 2015 | 2241 (20.1) | 767 (34.2) | 1474 (65.8) | 1.2 | ||
| 2016 | 2290 (20.5) | 794 (34.7) | 1496 (65.3) | 1.2 | ||
| 2017 | 2316 (20.8) | 770 (33.3) | 1546 (66.8) | 1.1 | ||
| Sex | < .001 | |||||
| Female | 454 (4.1) | 190 (41.9) | 264 (58.2) | 1 (Ref) | ||
| Male | 10 694 (95.9) | 3477 (32.5) | 7217 (67.5) | 0.8 | ||
| Age, y | < .001 | |||||
| 18 to < 35 | 1542 (13.8) | 803 (52.1) | 739 (47.9) | Ref | ||
| 35 to < 55 | 2400 (21.5) | 1011 (42.1) | 1389 (57.9) | 0.8 | ||
| 55 to < 75 | 4504 (40.4) | 1381 (30.7) | 3123 (69.3) | 0.6 | ||
| 75 to 115 | 2702 (24.2) | 472 (17.5) | 2230 (82.5) | 0.3 | ||
| Mean ± SD | 60.1 ± 18.7 | 53.6 ± 18.3 | 63.3 ± 18.0 | −0.5 | < .001 | |
| Race/ethnicity | < .001 | |||||
| White | 9009 (80.8) | 2854 (31.7) | 6155 (68.3) | 1 (Ref) | ||
| Black | 562 (5.0) | 179 (31.9) | 383 (68.2) | 1.0 | ||
| Hispanic | 284 (2.6) | 115 (40.5) | 169 (59.5) | 1.3 | ||
| Other | 849 (7.6) | 388 (45.7) | 461 (54.3) | 1.4 | ||
| Unknown | 444 (4.0) | 131 (29.5) | 313 (70.5) | 0.9 | ||
| Married | 4571 (41.0) | 1443 (31.6) | 3128 (68.4) | 0.9 | .01 | |
| Rurality of home address | .003 | |||||
| Urban | 7061 (64.2) | 2416 (34.2) | 4645 (65.8) | 1 (Ref) | ||
| Rural | 3931 (35.8) | 1237 (31.5) | 2694 (68.5) | 0.9 | ||
| Distance from home address to nearest VHA facility, miles | 12.8 ± 20.5 | 12.5 ± 21.9 | 13.0 ± 19.7 | 0.0 | .01 | |
| Region of the United States | < .001 | |||||
| Northeast | 1207 (10.8) | 372 (30.8) | 835 (69.2) | 1 (Ref) | ||
| Midwest | 2298 (20.6) | 852 (37.1) | 1446 (62.9) | 1.2 | ||
| South | 4648 (41.7) | 1264 (27.2) | 3384 (72.8) | 0.9 | ||
| West | 2992 (26.9) | 1179 (39.4) | 1813 (60.6) | 1.3 | ||
| Days since most recent VHA encounter | 85.4 ± 119.6 | 48.6 ± 86.5 | 103.5 ± 129.0 | −0.5 | < .001 | |
| Facility type of most recent VHA encounter | .002 | |||||
| VAMC | 6987 (62.7) | 2351 (33.7) | 4636 (66.4) | 1 (Ref) | ||
| CBOC | 3122 (28.0) | 952 (30.5) | 2170 (69.5) | 0.9 | ||
| Other | 1039 (9.3) | 364 (35.0) | 675 (65.0) | 1.0 | ||
| Setting of most recent VHA encounter | < .001 | |||||
| Outpatient primary care | 3089 (27.7) | 763 (24.7) | 2326 (75.3) | 1 (Ref) | ||
| Outpatient mental health | 2172 (19.5) | 1104 (50.8) | 1068 (49.2) | 2.1 | ||
| Outpatient emergency department | 256 (2.3) | 75 (29.3) | 181 (70.7) | 1.2 | ||
| Outpatient other | 5460 (49.0) | 1624 (29.7) | 3836 (70.3) | 1.2 | ||
| Inpatient mental health | 80 (0.7) | 44 (55.0) | 36 (45.0) | 2.2 | ||
| Inpatient non‒mental health | 91 (0.8) | 57 (62.6) | 34 (37.4) | 2.5 | ||
| Diagnoses in previous 12 mo | ||||||
| Any mental health or SUD diagnosis | 6178 (55.4) | 2796 (45.3) | 3382 (54.7) | 2.6 | < .001 | |
| Any SUD | 2508 (22.5) | 1245 (49.6) | 1263 (50.4) | 1.8 | < .001 | |
| Opioid SUD | 478 (4.3) | 257 (53.8) | 221 (46.2) | 1.7 | < .001 | |
| Bipolar disorder | 860 (7.7) | 439 (51.1) | 421 (49.0) | 1.6 | < .001 | |
| Schizophrenia | 383 (3.4) | 194 (50.7) | 189 (49.4) | 1.6 | < .001 | |
| Depression | 3989 (35.8) | 1950 (48.9) | 2039 (51.1) | 2.0 | < .001 | |
| Anxiety | 2252 (20.2) | 1077 (47.8) | 1175 (52.2) | 1.6 | < .001 | |
| PTSD | 2206 (19.8) | 1214 (55.0) | 992 (45.0) | 2.0 | < .001 | |
| Indication of homelessness in previous 12 mo | 687 (6.2) | 363 (52.8) | 324 (47.2) | 1.7 | < .001 | |
| Indication of suicide attempt in previous 12 mo | 471 (4.2) | 324 (68.8) | 147 (31.2) | 2.2 | < .001 | |
| Per ICD diagnosis codes | 257 (2.3) | 175 (68.1) | 82 (31.9) | 2.1 | < .001 | |
| Per SPAN | 341 (3.1) | 239 (70.1) | 102 (29.9) | 2.2 | < .001 | |
| No. of outpatient visit days in previous 12 mo | 17.4 ± 23.2 | 25.4 ± 28.0 | 13.4 ± 19.3 | 0.5 | < .001 | |
| No. of inpatient discharges in previous 12 mo | 0.34 ±1.03 | 0.55 ± 1.33 | 0.24 ± 0.83 | 0.3 | < .001 | |
| Clinical high risk for suicide flag in previous 12 mo | 626 (5.6) | 432 (69.0) | 194 (31.0) | 2.2 | < .001 | |
| Suicide safety plan in previous 12 mo | 703 (6.3) | 457 (65.0) | 246 (35.0) | 2.1 | < .001 | |
| Enrolled with VHA | 10 880 (97.6) | 3625 (33.3) | 7255 (66.7) | 2.1 | < .001 | |
| Missed at least 1 VHA appointment in previous 1 mo | 3888 (34.9) | 1729 (44.5) | 2159 (55.5) | 1.1 | .001 | |
| Mental health screening in previous 12 mo | ||||||
| Screened for major depressive disorder | 6493 (58.2) | 2170 (33.4) | 4323 (66.6) | 1.0 | .16 | |
| Screened for PTSD | 3630 (32.6) | 1370 (37.7) | 2260 (62.3) | 1.2 | < .001 | |
| Screened for alcohol use disorder | 8018 (71.9) | 2935 (36.6) | 5083 (63.4) | 1.6 | < .001 | |
| Method of suicide | < .001 | |||||
| Firearm | 7697 (69.0) | 2420 (31.4) | 5277 (68.6) | 1 (Ref) | ||
| Poisoning | 1280 (11.5) | 342 (26.7) | 938 (73.3) | 0.9 | ||
| Suffocation | 1561 (14.0) | 694 (44.5) | 867 (55.5) | 1.4 | ||
| Other | 610 (5.5) | 211 (34.6) | 399 (65.4) | 1.1 | ||
Note. CBOC = community-based outpatient clinic; ICD = International Statistical Classification of Diseases and Related Health Problems; PTSD = posttraumatic stress disorder; RR = relative risk; SPAN = Suicide Prevention Applications Network; SUD = substance use disorder; VAMC = Department of Veterans Affairs Medical Center; VHA = Veterans Health Administration.
a
P value derived from χ2, t test, or Wilcoxon rank sum test comparing facility-identified decedents and nonidentified decedents.