Mental Health
Geospatial Estimates of Suicidal Ideation and Suicide Attempt Prevalence in the U.S. Veteran Population (2022): The Importance of Disaggregation Julie Kittel* Julie Kittel Lindsey Monteith Ryan Holliday Alexandra Schneider Lisa Brenner Claire Hoffmire
Veteran suicide remains a major public health concern; rates increased from 2001 to 2022 and substantial geospatial variation exists. Surveillance of suicidal ideation (SI) and suicide attempts (SA) can provide insight to reduce suicide risk within communities. A population-based, cross-sectional survey of 17,946 Veterans residing in all 50 U.S. states, the District of Columbia, Puerto Rico, and U.S. Pacific Island (PI) Territories, was conducted in 2022 to assess SI and SA prevalence. Lifetime and post-military SI and SA and past-year SI prevalence, as well as proportions of SI methods were estimated by Census region, division, and state. Prevalence ratios were used to assess for post-military SI and SA differences by division. The West had the highest prevalence of lifetime (36.94%; 95%CI=34.65-39.23) and post-military SI (28.73%; 95%CI=26.51-30.96); for lifetime SI, prevalence was higher than all other regions except PI Territories and Puerto Rico. PI Territories had the highest prevalence of past-year SI (15.68%; 95%CI=10.91-20.44) and lifetime (9.86%; 95%CI=6.36-13.37) and post-military SA (5.67%; 95%CI=3.21-8.14). At the divisional level, the Pacific West had the highest prevalence of lifetime (36.99%; 95%CI=33.83-40.07) and post-military SI (29.12%; 95%CI=26.01-32.23) while West South Central had the highest prevalence of past-year SI (14.00%; 95%CI=11.59-16.40) and post-military SA (6.89%; 95%CI=5.07-8.70). The PI Territories remained highest for lifetime SA. After adjusting for covariates (age, race, gender, rurality, time since military separation), differences were not significant. Firearms were the most commonly considered method by Veterans in the Midwest, South, and West while motor vehicle collisions were most commonly considered in the Northeast and PI Territories. Further elucidation of differential factors and effective preventive efforts (e.g., lethal means safety) to address risk for Veterans across regions are paramount.
