Mental Health
Suicide Among Veteran Cancer Survivors: Rates and Methods, 2010-2020 Julie Kittel* Julie Kittel Alexandra Schneider Elissa Kolva Lindsey Monteith Claire Hoffmire
Of Veterans Health Administration (VHA)-using veterans who died by suicide in 2021, 39% had no known mental health (MH) or substance use diagnosis. While suicide rates among VHA-using veterans with MH diagnoses have declined, rates among those with no MH diagnosis increased 12% from 2001-2021. Future research on the role of physical health conditions, such as cancer, in suicide prevention is necessary to develop targeted intervention strategies. We compared suicide rates among VHA-using veterans: (1) with a cancer history other than non-melanoma skin cancer (n=439,667), and (2) an age and sex frequency matched cohort randomly selected from all VHA-using veterans between 2010-2020 with no history of cancer. The non-cancer group were assigned an index date from a VHA visit in the same month and year as the diagnosis date of the matched cancer patient. Medical, administrative and mortality data were obtained. Suicide rates were calculated overall and by time period (2010-2015, 2016-2020) and stratified by age. Cox proportional hazard models were fit to compare cancer and non-cancer groups. Frequencies and proportions of suicide methods were calculated by cancer history and age. History of cancer was associated with a 37% increased hazard of suicide after adjusting for MH and demographic characteristics (HR=1.37; 95% CI: 1.24, 1.50). Suicide rates were especially elevated among those 85 years of age and older. Of cancer survivors who died by suicide, 79.4% (95% CI: 76.6, 82.0) used a firearm, compared to 72.3% (95% CI: 69.2, 75.2) with no cancer history. Firearm use was more prevalent in cancer survivors ages 70-84 (89.9%; 95% CI: 86.4, 92.8). Veteran cancer survivors are at increased risk for suicide and are more likely to use firearms as their suicide method. This risk is especially pronounced in older veterans. These findings can directly inform suicide risk assessment in this population. Future research should identify risk and protective factors in this population.