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. 2023 Oct 2;6(10):e2337679.
doi: 10.1001/jamanetworkopen.2023.37679.

Suicide Ideation, Plans, and Attempts Among Military Veterans vs Nonveterans With Disability

Rebecca K Blais  1 , Zhigang Xie  2 , Anne V Kirby  3 , Nicole M Marlow  4
Affiliations

Suicide Ideation, Plans, and Attempts Among Military Veterans vs Nonveterans With Disability

Rebecca K Blais et al. JAMA Netw Open. .

Abstract

Importance: People with disability are at heightened risk for suicide ideation, planning, and attempt, with risk growing as the number of disabling limitations increases. Military veterans have higher rates of suicide deaths and disability relative to nonveterans.

Objective: To evaluate whether veteran status is associated with greater risk for suicide in those with disability.

Design, setting, and participants: This survey study used cross-sectional self-reported data from US adults who participated in the 2015-2020 National Survey on Drug Use and Health. Data were weighted to represent the population. Data analysis was conducted from July to August 2022.

Main outcomes and measures: Suicide ideation, planning, and attempt served as primary outcomes. Disability status (present or absent) and number of disabling limitations (1, 2, or ≥3) served as factors. Veteran status was determined based on self-report (veteran or nonveteran). Multivariable logistic regression examined suicide ideation, planning, and attempt as a function of veteran status and disability variables.

Results: Participants included 231 099 US veterans and nonveterans, representing 236 551 727 US adults, of whom 20.03% (weighted n = 47 397 876) reported a disabling limitation, 8.92% were veterans (weighted n = 21 111 727; 16.0% aged 35-49 years; 91.0% men; 6.7% Hispanic; 10.9% non-Hispanic Black; and 78.4% non-Hispanic White) and 91.08% were nonveterans (weighted n = 215 440 000; 25.4% aged 35-49 years; 44.0% male; 16.5% Hispanic; 11.7% non-Hispanic Black; and 63.3% non-Hispanic White). Overall, 4.39% reported suicide ideation, planning, or attempt (weighted n = 10 401 065). Among those with no disability, veteran status was associated with higher risk of suicide planning (adjusted odds ratio [AOR], 1.71; 95% CI, 1.17-2.49). Among those with 1 or 2 disabling limitations, being a veteran was associated with a lower risk of suicide planning (AOR, 0.57; 95% CI, 0.34-0.95) and history of attempt (AOR, 0.46; 95% CI, 0.24-0.88).

Conclusions and relevance: In this study of how suicide risk differs as a function of disability and veteran status, risk for death by suicide was lower among veterans with disability relative to nonveterans with disability. Veteran status may mitigate risk for suicide given increased receipt of more disability-related care through the Department of Veterans Affairs. Further research would extend this line of inquiry by examining the cause and type of disability as well as perceptions of disability on self-worth. It is possible that physical wounds of war are protective because of the meaning and value of service to one's country.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Kirby reported receiving grants from the National Institute of Mental Health during the conduct of the study as well as grants from the US Centers for Disease Control and Prevention and personal fees from University of Pittsburgh outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Study Cohort Selection Criteria and Process
Flowchart of participant selection from the National Survey on Drug Use and Health (NDSUH) database.
See this image and copyright information in PMC

References

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