New suicidality in veterans during pandemic linked to preexisting mental health

Key takeaways:

• Most veterans did not have increased suicidal thoughts and behaviors during the COVID-19 pandemic.
• Preexisting loneliness, distress and lower purpose in life were associated with new-onset suicidality.

Veterans with feelings of loneliness and lower life purpose that preceded the COVID-19 pandemic had greater odds of developing new suicidal thoughts or behaviors during the pandemic, data published in JAMA Psychiatry showed.

Ian C. Fischer, PhD, of the Department of Veterans Affairs National Center for Posttraumatic Stress Disorder at the VA Connecticut Healthcare System, and colleagues used data from the National Health and Resilience in Veterans Study to assess suicidality in veterans.

Participants completed a survey before the onset of the pandemic (median completion, Nov. 21, 2019), during the fall and winter of 2020 before vaccines were widely available (median completion, Nov. 14, 2020) and during the late summer of 2022 (median completion, Aug. 18, 2022). The first collected information on recent and lifetime suicidality; the second also collected information on pandemic-related stressors; and the third also collected information on infection-related stressors and changes in suicide risk factors.

In total, 2,441 veterans (mean age, 63.2 years) completed all three surveys. Most of the veterans were male (92.1%) and non-Hispanic white (79.5%). Over the study period, nine veterans reported attempting suicide, 100 reported new-onset suicidal thoughts and 28 reported new-onset suicide planning.

Past-year suicidal ideation decreased from 9.3% at the pre-pandemic survey to 6.8% at the second survey, then increased to 7.7% at the third survey.

Adjusted analyses revealed that reports of new suicidal ideation were associated with greater educational attainment (adjusted OR = 3.27; 95% CI, 1.95-5.46), lifetime substance use disorder (aOR = 2.07; 95% CI, 1.23-3.46) and pre-pandemic loneliness (aOR = 1.28; 95% CI, 1.09-1.49) and lower purpose in life (aOR = 0.92; 95% CI, 0.86-0.97).

Lower pre-pandemic purpose in life was also associated with new-onset suicide planning during the pandemic (aOR = 0.88; 95% CI, 0.81-0.95), as were lifetime substance use disorder (aOR = 3.03; 95% CI, 1.22-7.55) and higher pre-pandemic psychiatric distress (aOR = 1.52; 95% CI, 1.06-2.18).

“Collectively, these results suggest that efforts to promote purpose in life and social connectedness, as well as treatments that target ongoing psychiatric distress and substance use problems, should be prioritized to help mitigate suicide risk in U.S. military veterans,” Fischer and colleagues wrote. “Further research is needed to replicate these results in other population-based samples, identify within-person factors that contribute to fluctuations in suicide risk and evaluate the effectiveness of interventions targeting key risk and protective factors that mitigate suicide risk as veterans and the world at large begin to emerge from the COVID-19 pandemic.”