Mortality following non-fatal suicide attempts by Veterans in Veterans Health Administration care.

Abstract

Little is known regarding long-term mortality outcomes after non-fatal suicide attempts among Veterans Health Administration (VHA) patients, which may inform services delivery and program evaluation. For 4,601,081 Veterans with 2005 VHA encounters, we assessed unadjusted and age-adjusted all-cause and cause-specific mortality through 2017, overall and for Veterans with (N=8243) versus without (N=4,592,838) 2005 VHA suicide attempt documentation. Standardized mortality ratios compared mortality rates by suicide attempt status. Multivariable proportional hazards regression models assessed age- and gender-adjusted mortality risk. Among Veteran VHA users with non-fatal suicide attempt diagnoses, 1.6% died of suicide, 4.6% of non-suicide external causes, and 30.7% of any cause. In age- and gender-adjusted analyses, Veterans who attempted suicide had increased suicide (hazard ratio [HR]=4.52, 95% confidence interval [CI]=3.82-5.36), non-suicide external cause (HR=3.75, 95% CI=3.38-4.17), and all-cause (separate due to non-proportional hazards: 2006, HR=2.05, 95% CI=1.81-2.31; 2007-2017, HR=1.72, 95% CI=1.65-1.80) mortality through 2017. Over 12years, Veteran VHA patients with non-fatal suicide attempt diagnoses had increased risk of suicide, non-suicide external cause, and all-cause mortality. Over 98% of Veteran VHA users who had a diagnosed non-fatal attempt did not die by suicide, highlighting additional program evaluation outcomes and opportunities to support physical and mental health.