Suicidal Thoughts and Behaviors in Older U.S. Military Veterans: Results From the National Health and Resilience in Veterans Study

Overview

Journal Am J Geriatr Psychiatry

Publisher Elsevier

Specialty Geriatrics

Date 2023 May 21

PMID 37211498

Authors

Ian C Fischer

Brandon Nichter

Frances M Aunon

David B Feldman

Becca R Levy

Irina Esterlis

Robert H Pietrzak

Affiliations

Soon will be listed here.

Abstract

Objective: To identify the prevalence and correlates associated with suicidal thoughts and behaviors (STBs) in a nationally representative sample of older (55+) US military veterans.

Methods: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (N = 3,356; mean age = 70.6). Self-report measures of past-year suicidal ideation (SI), lifetime suicide plan, lifetime suicide attempt(s), and future suicide intent were examined in relation to sociodemographic, neuropsychiatric, trauma, physical health, and protective factors.

Results: A total of 6.6% (95% CI = 5.7%-7.8%) of the sample endorsed past-year SI, 4.1% (CI = 3.3%-5.1%) a lifetime suicide plan, 1.8% (CI = 1.4%-2.3%) a lifetime suicide attempt, and 0.9% (CI = 0.5%-1.3%) future suicide intent. Higher levels of loneliness and lower levels of purpose in life were most strongly associated with past-year SI; lifetime history of major depressive disorder with suicide plan and suicide attempt; and frequency of past-year SI and more negative expectations regarding emotional aging with future suicide intent.

Conclusion: These findings provide the most up-to-date nationally representative prevalence estimates of STBs among older military veterans in the United States. Several modifiable vulnerability factors were found to be associated with suicide risk in older US military veterans, suggesting that these factors may be targets for intervention in this population.

References

Straus E, Norman S, Tripp J, Pitts M, Pietrzak R . Purpose in Life and Conscientiousness Protect Against the Development of Suicidal Ideation in U.S. Military Veterans With PTSD and MDD: Results From the National Health and Resilience in Veterans Study. Chronic Stress (Thousand Oaks). 2019; 3. PMC: 6880965. DOI: 10.1177/2470547019872172. View

Nock M, Borges G, Bromet E, Alonso J, Angermeyer M, Beautrais A . Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry. 2008; 192(2):98-105. PMC: 2259024. DOI: 10.1192/bjp.bp.107.040113. View

Pietrzak R, Levy B, Tsai J, Southwick S . Successful Aging in Older US Veterans: Results From the 2019-2020 National Health and Resilience in Veterans Study. Am J Geriatr Psychiatry. 2020; 29(3):251-256. PMC: 10697787. DOI: 10.1016/j.jagp.2020.08.006. View

Sun F, Chiu N, Yao Y, Wu M, Hung C, Chen C . The effects of logotherapy on meaning in life, depression, hopelessness, and suicidal ideation, in patients with depression: An intervention study. Perspect Psychiatr Care. 2021; 58(4):1891-1899. DOI: 10.1111/ppc.13003. View

Na P, Jeste D, Pietrzak R . Social Disconnection as a Global Behavioral Epidemic-A Call to Action About a Major Health Risk Factor. JAMA Psychiatry. 2022; 80(2):101-102. PMC: 11112624. DOI: 10.1001/jamapsychiatry.2022.4162. View

Kim E, Shiba K, Boehm J, Kubzansky L . Sense of purpose in life and five health behaviors in older adults. Prev Med. 2020; 139:106172. PMC: 7494628. DOI: 10.1016/j.ypmed.2020.106172. View

Ivey-Stephenson A, Crosby A, Hoenig J, Gyawali S, Park-Lee E, Hedden S . Suicidal Thoughts and Behaviors Among Adults Aged ≥18 Years - United States, 2015-2019. MMWR Surveill Summ. 2022; 71(1):1-19. PMC: 8736267. DOI: 10.15585/mmwr.ss7101a1. View

Laglaoui Bakhiyi C, Calati R, Guillaume S, Courtet P . Do reasons for living protect against suicidal thoughts and behaviors? A systematic review of the literature. J Psychiatr Res. 2016; 77:92-108. DOI: 10.1016/j.jpsychires.2016.02.019. View

Sullivan J, Simons K, Mills W, Hilgeman M, Freytes I, Morin R . A Paucity of Data on Veterans 65 and Older and Risk of Suicide: A Systematic Review. Am J Geriatr Psychiatry. 2022; 31(7):525-539. DOI: 10.1016/j.jagp.2022.11.005. View

10.

McClelland H, Evans J, Nowland R, Ferguson E, OConnor R . Loneliness as a predictor of suicidal ideation and behaviour: a systematic review and meta-analysis of prospective studies. J Affect Disord. 2020; 274:880-896. DOI: 10.1016/j.jad.2020.05.004. View

11.

Kaplan M, McFarland B, Huguet N, Valenstein M . Suicide risk and precipitating circumstances among young, middle-aged, and older male veterans. Am J Public Health. 2012; 102 Suppl 1:S131-7. PMC: 3496453. DOI: 10.2105/AJPH.2011.300445. View

12.

Osman A, Bagge C, Gutierrez P, Konick L, Kopper B, Barrios F . The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples. Assessment. 2002; 8(4):443-54. DOI: 10.1177/107319110100800409. View

13.

Franklin J, Ribeiro J, Fox K, Bentley K, Kleiman E, Huang X . Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychol Bull. 2016; 143(2):187-232. DOI: 10.1037/bul0000084. View

14.

Fanning J, Pietrzak R . Suicidality among older male veterans in the United States: results from the National Health and Resilience in Veterans Study. J Psychiatr Res. 2013; 47(11):1766-75. DOI: 10.1016/j.jpsychires.2013.07.015. View

15.

Church K, Munro S, Shaughnessy M, Clancy C . Age-Friendly Health Systems: Improving care for older adults in the Veterans Health Administration. Health Serv Res. 2022; 58 Suppl 1:5-8. PMC: 9843073. DOI: 10.1111/1475-6773.14110. View

16.

Mota N, Tsai J, Kirwin P, Sareen J, Southwick S, Pietrzak R . Purpose in Life is Associated with a Reduced Risk of Incident Physical Disability in Aging U.S. Military Veterans. Am J Geriatr Psychiatry. 2016; 24(9):706-14. DOI: 10.1016/j.jagp.2016.03.004. View

17.

Kligler B, Hyde J, Gantt C, Bokhour B . The Whole Health Transformation at the Veterans Health Administration: Moving From "What's the Matter With You?" to "What Matters to You?". Med Care. 2022; 60(5):387-391. DOI: 10.1097/MLR.0000000000001706. View

18.

Morin R, Li Y, Mackin R, Whooley M, Conwell Y, Byers A . Comorbidity Profiles Identified in Older Primary Care Patients Who Attempt Suicide. J Am Geriatr Soc. 2019; 67(12):2553-2559. PMC: 6898743. DOI: 10.1111/jgs.16126. View

19.

Straus E, Norman S, Haller M, Southwick S, Hamblen J, Pietrzak R . Differences in protective factors among U.S. Veterans with posttraumatic stress disorder, alcohol use disorder, and their comorbidity: Results from the National Health and Resilience in Veterans Study. Drug Alcohol Depend. 2018; 194:6-12. DOI: 10.1016/j.drugalcdep.2018.09.011. View