Palliative Care Consultation is Associated with Lower Odds of Suicide among Veterans at High Risk of One-Year Mortality

BACKGROUND:
Increased suicide risk has been linked to physical and mental health conditions and is substantially higher in people living with multiple chronic conditions, who also have high risk of short-term mortality, report lower quality of life, and experience symptoms like pain and hopelessness. Palliative care strives to optimize quality of life and reduce symptoms for patients living with life-limiting conditions. Palliative care consultations (PCCs) target the physical, psychological, and spiritual needs of patients and families; however, little is known about the association between PCC and suicide. This observational cohort study examined the association between the number of PCCs and documented suicide in a cohort of Veterans at high risk of short-term mortality. Using VA data, investigators identified 580,620 Veteran decedents between November 2012 and December 2017 with a high risk of one-year mortality; of these, 1,677 died by suicide. Investigators assessed the presence of 26 physical health conditions (e.g., hypertension, diabetes, COPD) and 14 mental health (e.g., depression, anxiety) and substance use (e.g., alcohol and opioid use disorders) conditions.

FINDINGS:

• Receipt of PCC within 90 days of death was associated with a 71-78% decrease in the odds of suicide compared to other causes among Veterans at high risk of one-year mortality. The largest reduction in odds of death by suicide was among those who had received two or more PCCs.
• Among Veterans who died by suicide, 5% received at least one PCC in the 90 days prior to death compared to 16% who died from other causes.
• Higher percentages of Veterans who died by suicide were diagnosed with chronic pulmonary disease as well as mental health/substance use conditions compared with Veterans who died from other causes.

IMPLICATIONS:

• Additional studies are needed that identify the specific aspects of PCCs that help prevent suicide, such as the configuration of palliative care teams (e.g., inclusion of a mental health provider) and specific interventions (e.g., psychosocial support) that could also be applied by primary care, mental health, or tele-mental health teams.

LIMITATIONS:

• Access to PCC was not randomized; therefore, Veterans who were offered and chose to pursue PCC may have differed systematically from those who did not.
• Omitted variables may introduce bias. For example, study models did not account for the receipt of PCCs or diagnoses received outside VA, mental health treatment, or known suicide risk factors (i.e., social isolation and access to lethal means).

AUTHOR/FUNDING INFORMATION:
Dr. Kutney-Lee is part of HSR&D’s Center for Health Equity, Research and Promotion (CHERP) and the Veteran Experience Center at the Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA.

Kutney-Lee A, Khazanov G, Carpenter J, et al. Palliative Care and Documented Suicide: Association among Veterans with High Mortality Risk. Journal of Pain and Symptom Management. Published online April 27, 2022.