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A Paucity of Data on Veterans 65 and Older and Risk of Suicide: A Systematic Review

  • Jennifer L. Sullivan
    Correspondence
    Send correspondence and reprint requests to Jennifer L Sullivan, Ph.D., Center of Innovation in Long Term Services and Supports (LTSS COIN), VA Providence Healthcare System, Capt. Jonathan H. Harwood Jr. Center for Research, 385 Niagra Street, Providence, 02907 RI.
    Affiliations
    Center for Innovation in Long-Term Services & Supports (JLS, WLM), Providence VA Medical Center, Providence, RI

    Department of Health Services, Policy and Practice, School of Public Health (JLS, WLM), Brown University, Providence, RI
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  • Kelsey V. Simons
    Affiliations
    VISN 2 Center of Excellence for Suicide Prevention (KVS), Canandaigua VA Medical Center, Canandaigua, NY

    Department of Psychiatry (KVS), University of Rochester School of Medicine and Dentistry, Rochester, NY
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  • Whitney L. Mills
    Affiliations
    Center for Innovation in Long-Term Services & Supports (JLS, WLM), Providence VA Medical Center, Providence, RI

    Department of Health Services, Policy and Practice, School of Public Health (JLS, WLM), Brown University, Providence, RI
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  • Michelle M. Hilgeman
    Affiliations
    Tuscaloosa VA Medical Center (MMH), Tuscaloosa, AL

    The University of Alabama (UA), Psychology Department (MMH), Tuscaloosa, AL

    University of Alabama at Birmingham (UAB), Department of Medicine, Division of Gerontology, Geriatrics, & Palliative Care (MMH), Birmingham, AL
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  • Ivette M. Freytes
    Affiliations
    Research Section, Malcom Randall VAMC (IMF), Gainesville, FL

    VA North Florida/South Georgia Veterans Health System (IMF), Gainesville, FL
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  • Ruth T. Morin
    Affiliations
    Hoag Memorial Hospital Presbyterian (RTM), Newport Beach, CA

    San Francisco Veterans Affairs Health Care System (RTM), San Francisco, CA

    Department of Veterans Affairs Medical Center (RTM), Center for Imaging of Neurodegenerative Diseases, San Francisco, CA
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  • Emily S. Bower
    Affiliations
    Department of Psychiatry (ESB), University of Rochester School of Medicine & Dentistry, Rochester, NY
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  • Ryan Clark
    Affiliations
    Department of Medicine (RC, ALB), University of California, San Francisco, CA

    Research Service, San Francisco Veterans Affairs Health Care System (RC, ALB), San Francisco, CA
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  • Amy L. Byers
    Affiliations
    Department of Medicine (RC, ALB), University of California, San Francisco, CA

    Research Service, San Francisco Veterans Affairs Health Care System (RC, ALB), San Francisco, CA

    Department of Psychiatry and Behavioral Sciences (ALB), University of California, San Francisco

    Weill Institute for Neurosciences (ALB), University of California, San Francisco
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Published:November 11, 2022DOI:https://doi.org/10.1016/j.jagp.2022.11.005

      Highlights

      • What is the primary question addressed in this study? What are the risk and protective factors related to suicide outcomes among older veterans 65 years of age and older?
      • What is the main finding of this study? We found five domains of explanatory factors studied (i.e., neuropsychiatric, social determinants of health, aging stereotypes, residential and supportive housing settings, and multifactorial–neuropsychiatric/mental health and physical health) with more risk factors than protective factors reported.
      • What is the meaning of the finding? Our study suggests there are unique factors affecting risk of suicide for older veterans. Thus, more innovative targets to consider for intervention and more innovative methods to predict suicide in late-life are needed.

      ABSTRACT

      Older veterans are vastly underrepresented in studies that shape national suicide prevention strategies. This is of great concern because factors that impact younger veterans may not be as robust in later life. Although younger veterans have higher rate of suicide, the highest counts of death by suicide are in older veterans. However, it remains unclear from the extant literature what factors may influence increased or decreased risk of late-life suicide in veterans. The objective of this systematic review was to identify risk and protective factors related to suicide outcomes (i.e., ideation, attempt, death, or suicide-related behavior [SRB]) among older veterans. Furthermore, it offers data regarding future study directions and hypothesis generation for late-life suicide research and for informing potential intervention and prevention efforts in this area. We searched 4 databases from inception up to May 5, 2022. We screened 2,388 abstracts for inclusion and 508 articles required full text review. The final sample included 19 studies published between 2006 and 2022. We found five domains of factors studied (i.e., neuropsychiatric, social determinants of health, aging stereotypes, residential and supportive housing settings, and multifactorial–neuropsychiatric/mental health and physical health) with more risk factors than protective factors reported. Across the three suicide outcomes only neuropsychiatric factors were consistently identified as risk factors. Neuropsychiatric factors also comprised the largest group of risk factors studied. More innovative targets to consider for intervention and more innovative methods to predict suicide in late-life are needed. There is also continued necessity to design suicide prevention interventions for older veterans given lethality trends.

      Key Words

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