Younger Veterans with Mental Health Conditions, and Older Veterans with Physical Health Conditions, at High Risk of Suicide Attempt or Self-Directed Violence After COVID-19 Infection

BACKGROUND:
Veterans have a higher risk of suicide compared to the general population. Research suggests COVID-19 infection can increase the risk of suicide attempts or other forms of self-directed violence (SDV) among Veterans. In this study, researchers used the electronic health records of 285,235 Veterans (87% male, 69% White, 60% less than 65 years old) with a first case of COVID-19 infection between May 1, 2021, and April 30, 2022, to identify subgroups of Veterans with high risk of post-COVID-19 suicide attempts or other SDV. The main outcome was a suicide attempt or other SDV within 12 months after COVID-19 infection.

FINDINGS:

• Within 12 months after infection, 2,106 Veterans had suicide attempts or other SDV events (74 per 10,000 Veterans). Suicide attempts accounted for 53% of events.
• Two distinct Veteran subgroups accounted for 87% of suicide attempts or other SDV events within 12 months of COVID-19 infection:
  • The first high-risk subgroup (n=82,309 Veterans) was mostly younger (84% less than age 65), with a high prevalence of mental health conditions (75% depression, 61% PTSD), and had a 12-month outcome rate of 163 per 10,000 Veterans—14 times higher than the rate among the lowest risk subgroup.
  • The second high-risk subgroup (n=46,693 Veterans) was mostly older (74% aged 65 or older) with a high prevalence of chronic physical conditions (93% hypertension, 79% chronic pain), and had a 12-month outcome rate of 104 per 10,000 Veterans.

IMPLICATIONS:

• Additional suicide screening after COVID-19 may be warranted for high-risk subgroups (younger Veterans with mental health conditions and older Veterans with chronic physical conditions); tailored suicide prevention approaches for addressing unique risk and protective factors specific to each subgroup may mitigate risk.

LIMITATIONS:

• During the study’s timeframe, home COVID-19 testing became more common and fewer patients were testing in VHA facilities, which limits inferences to Veterans who would have sought testing in VHA facilities despite the availability of home testing.
• As milder cases of COVID-19 are unlikely to be reported to VHA, Veterans in the cohort likely over-represented cases with severe illness.

AUTHOR/FUNDING INFORMATION:
This study was funded by VA’s Office of Research & Development HSR portfolio. Drs. Bui and Niederhausen and Mr. Hickok are with HSR’s Center to Improve Veteran Involvement in Care (CIVIC). All authors are part of the VA HSR COVID-19 Observational Research Collaboratory (CORC).

Bui D, Niederhausen M, Hickok A, et al. Veterans at High Risk for Post-COVID-19 Suicide Attempts or Other Self-directed Violence. JAMA Network Open. March 4, 2025;8(3):e250061