Factors associated with multiple suicide attempts in a nationally representative study of U.S. military veterans

Brandon Nichter; Shira Maguen; Lindsey L Monteith; Lorig Kachadourian; Sonya B Norman; Melanie L Hill; Sarah Herzog; Robert H Pietrzak

doi:10.1016/j.jpsychires.2021.06.012

Factors associated with multiple suicide attempts in a nationally representative study of U.S. military veterans

J Psychiatr Res. 2021 Aug:140:295-300. doi: 10.1016/j.jpsychires.2021.06.012. Epub 2021 Jun 7.

Authors

Brandon Nichter¹, Shira Maguen², Lindsey L Monteith³, Lorig Kachadourian⁴, Sonya B Norman⁵, Melanie L Hill⁶, Sarah Herzog⁷, Robert H Pietrzak⁸

Affiliations

¹ Department of Psychiatry, University of California Sn Diego, La Jolla, CA, USA. Electronic address: bnichter@ucsd.edu.
² San Francisco VA Health Care System, San Francisco, CA, USA; University of California - San Francisco, San Francisco, USA.
³ VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁴ National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, New Haven, CT, USA.
⁵ Department of Psychiatry, University of California Sn Diego, La Jolla, CA, USA; National Center for PTSD, White River Junction, VT, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.
⁶ Department of Psychiatry, University of California Sn Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA.
⁷ Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA.
⁸ Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA; Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.

PMID: 34126423
DOI: 10.1016/j.jpsychires.2021.06.012

Abstract

Objective: Veterans with a history of multiple suicide attempts are at increased risk for suicide mortality relative to those with a single attempt. However, little is known about factors that differentiate veterans who attempt suicide once compared to more than once. This study examined factors that distinguish single suicide attempters (SSA) from multiple suicide attempters (MSA) in a nationally representative sample of U.S. military veterans.

Methods: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a representative sample of 4069 U.S. veterans.

Analyses: (a) estimated the lifetime prevalence of SSA and MSA; and (b) examined factors that differentiated veterans with a SSA from MSA.

Results: The lifetime prevalences of SSA and MSA were 1.9% and 2.0%. The strongest correlates of MSA were history of lifetime depression (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.43-8.35), non-suicidal self-injury (OR, 3.28; 95% CI, 1.27-8.45), drug use disorder (OR, 4.0; 95% CI, 1.67-9.54), and marital status (OR, 0.40, 95% CI, 0.18-0.87), which accounted for 15.5%-41.4% of the total explained variance in MSA.

Discussion: Half of military veterans who have attempted suicide in the United States report more than one attempt, suggesting that suicide attempts are not a one-time occurrence for a substantial proportion of veterans. Veterans who attempt suicide more than once show more deliberate self-harm behavior and have greater psychiatric comorbidities relative to single attempters. Implications for future research examining risk factors for suicide attempts among veterans are discussed.

Keywords: Ideation to action; Military; Risk factors; Suicide; Suicide attempts; Veterans.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Humans
Prevalence
Risk Factors
Suicidal Ideation
Suicide, Attempted*
United States / epidemiology
Veterans*

Grants and funding

IK2 CX001259/CX/CSRD VA/United States