# Veterans at High Risk for Post–COVID-19 Suicide Attempts or Other Self-Directed Violence

## TL;DR

This study finds that two groups of veterans with different health profiles are at high risk for suicide attempts or self-harm after recovering from COVID-19.

## Contribution

The study identifies two distinct subgroups of veterans with elevated post-COVID-19 suicide risk using latent class analysis.

## Key findings

- Two subgroups of veterans with high rates of post-COVID-19 suicide attempts or self-directed violence were identified.
- One subgroup was older with physical health issues, while the other was younger with mental health conditions.
- The younger subgroup had a 14 times higher risk of suicide attempts or self-directed violence compared to the lowest-risk group.

## Abstract

Which subgroups of veterans are at high risk for suicide attempt or other forms of self-directed violence (SDV) after COVID-19 infection?

By use of a cohort study design and latent class analysis, among a total of 285 235 veterans with COVID-19, 2 subgroups with high rates of post–COVID-19 suicide attempts and SDV were identified. The subgroups had distinct demographics, health profiles, and health care utilization.

Given the increased risk of suicide attempt and SDV after COVID-19, these results could inform ways to tailor suicide prevention to veterans at highest risk.

This cohort study examines characteristics of US veterans who are at high risk of suicide attempts or other self-directed violence after COVID-19 infection.

US veterans have a higher risk of suicide than the general civilian population. Research suggests that COVID-19 infection is associated with increased risk of suicide attempts or other forms of self-directed violence (SDV) among veterans.

To identify subgroups of veterans with high risk of post–COVID-19 suicide attempts or SDV.

This is a retrospective cohort study conducted using data from the Veteran Health Administration (VHA). Participants included VHA enrollees with a first case of COVID-19 between May 1, 2021, and April 30, 2022, residing in the 50 states or Washington, DC.

COVID-19 infection.

The main outcome was a suicide attempt or SDV 12 months after COVID-19 infection. Latent class analysis was used to identify subgroups. Outcome rates and 95% CIs per 10 000 veterans were calculated. Multinomial regressions were used to model outcome risk and marginal risk ratios with 99.5% CIs to compare outcome risk across latent classes.

The cohort included 285 235 veterans with COVID-19 and was predominantly male (248 118 veterans [87.0%]) and younger than 65 years (171 636 veterans [60.2%]). Chronic pain (152 788 veterans [53.6%]), depression (98 093 veterans [34.4%]), and posttraumatic stress disorder (79 462 veterans [27.9%]) diagnoses were common. The 12-month outcome rate was 73.8 events per 10 000 (95% CI, 70.7-77.0 events per 10 000). Two latent classes with high rates of suicide attempt or SDV were identified. The first high-risk subgroup (46 693 veterans [16.4%]) was older (34 472 veterans [73.8%] aged ≥65 years) and had a high prevalence of physical conditions (43 329 veterans [92.8%] had hypertension, and 36 824 veterans [78.9%] had chronic pain); the 12-month outcome rate was 103.7 events per 10 000 (95% CI, 94.7-113.3 events per 10 000). The second high-risk subgroup (82 309 veterans [28.9%]) was generally younger (68 822 veterans [83.6%] aged <65 years) with a lower prevalence of physical conditions but high prevalence of mental health conditions (61 367 veterans [74.6%] had depression, and 50 073 veterans [60.8%] had posttraumatic stress disorder); the 12-month outcome rate was 162.9 events per 10 000 (95% CI, 154.5-171.8 events per 10 000), and compared with the lowest risk subgroup, the 12-month risk of suicide attempts or SDV was 14 times higher in this subgroup (risk ratio, 14.23; 99.5% CI, 10.22-19.80).

In this cohort study of veterans with COVID-19, 2 veteran subgroups with distinct health profiles had high rates of suicide attempts and SDV, suggesting that different groups may require different approaches to suicide prevention after COVID-19.