Suicide and Homelessness Veterans
The National Center on Homelessness among Veterans established the Homeless Evidence and Research Synthesis (HERS) Roundtable Series in 2015 as a policy forum. The virtual symposium convenes researchers and subject matter experts to discuss research findings on key issues in homelessness. The Suicide and Homeless Veterans Proceedings are a summary of the presentations and roundtable discussion that took place on February 27, 2018.
Suicide is a major public health issue in the United States; it claims over 42,000 lives a year making it the tenth leading cause of death in the United States. In August 2016, VA published a comprehensive report, Suicide Among Veterans and Other Americans 2001 – 2014, which revealed that in 2014 an average of 20 Veterans died by suicide every day. Fourteen of the 20 were not receiving VA services in the year of their suicide or the year prior. Sixty-five percent of Veteran suicides occurred in individuals 50 or older and 67% of Veteran suicides involved a firearm. After accounting for differences in age and gender, Veteran risk for suicide is 22% greater than that of civilian adults. Preventing Veteran suicide is a top clinical priority for the Department of Veterans Affairs and the identification of Veterans at elevated clinical or statistical risk for suicide is an important strategy in this effort.
Recent research on cause of death and mortality risk in homeless Veterans by John Schinka and colleagues has shown that homelessness is associated with an increased rate of all-cause mortality and of suicide in Veterans. A study published by John McCarthy found that the suicide rate among Veterans with homelessness in the past year was 81.0 per 100,000 as compared to Veterans without recent history of homelessness with a rate of 35.8 suicides per 100,000.
Consistent with the reported high rates of death by suicide in homeless Veterans are studies examining the suicidal behaviors of ideation and suicidal attempt. A systematic review of published studies presented by Lisa Brenner reported rates of suicidal ideation among Veterans of 1.3 to 7% for the past week, 12.1%–18% for the past 30 days, and as high as 74% for lifetime. For suicide attempts, reported rates within samples of homeless Veterans ranged from 0% to 6% for the past 30 days and 30.7%–31.5% for the past 5 years.
National Center on Homelessness among Veterans researchers Dorota Szymkowiak and Dennis Culhane recently examined the temporal sequencing of episodes of homelessness and the occurrence of suicidal behaviors, specifically of attempts and ideation. They found a clear temporal relationship between homelessness and suicidality. Notably, it appears that suicidality peaks just before onset of homelessness and not after. There is a sharp acceleration in suicidal behavior in the eight weeks prior to onset of homeless with a mirror deceleration in the eight weeks post onset. Nearly a third (29.3%) of Veterans receiving care for suicidality showed evidence of homelessness. Homelessness appeared especially prevalent among Veterans with primary diagnoses of suicidality in acute care settings, 39.7% of whom showed evidence of homelessness before and/or after the acute care encounter.
Keita Franklin and Aaron Eagan of VHA’s Office of Mental Health and Suicide Prevention discussed VA’s multifaceted strategy to impact the overall Veteran suicide crisis. Efforts include identifying Veterans at elevated clinical and/or statistical risk for suicide, outreaching to high risk Veterans, expanding community partnerships, improving use of data for surveillance and decision making, and advancing lethal means safety. As discussed by the Roundtable Panel, these broad actions are relevant to homeless Veterans. The elevated baseline suicide risk amongst homeless and at risk for homelessness Veterans and the high percentage of Veteran suicides outside of the VA system suggest additional opportunities may exist to both tailor prevention work for the homeless population and leverage the experiences of VA’s homeless efforts to advance outreach and engagement for unenrolled Veterans.
Read the full proceedings attached below.
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