Suicide Among American Indian and Alaska Native Veterans Who Use Veterans Health Administration Care

Mohatt, Nathaniel V.; Hoffmire, Claire A.; Schneider, Alexandra L.; Goss, Cynthia W; Shore, Jay H.; Spark, Talia L.; Kaufman, Carol E.

doi:10.1097/mlr.0000000000001656

Cited by 10 publications

(9 citation statements)

References 18 publications

(49 reference statements)

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“…Given that American Indian/Alaska Native (AI/AN) individuals have higher rates of suicide than other racial/ethnic groups (Leavitt et al, 2018) and the trend of increasing rates of suicide among AI/AN veterans who use VA health care (Mohatt, Hoffmire, et al, 2022), Mohatt, Begay, et al (2023) conducted a scoping review of programs to identify strong practices for preventing suicide among AI/AN veterans. With the goal of creating suicide prevention programs to meet the needs of AI/AN veterans, the authors followed scoping review guidelines established by Arksey and O’Malley (2005).…”

Section: Literature Reviewsmentioning

confidence: 99%

Introduction to the special issue: Improving access and quality of mental health care for diverse populations.

Iwamasa¹,

Gray²,

Klee³

2023

Psychological Services

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We are pleased to share this Psychological Services special issue on clinical services and research addressing access and quality of mental health services for culturally diverse populations. Disparities in mental health services are well-known. Indeed, the extent of the vast differences in access to and quality of care resulted in the establishment by the National Institute of Mental Health’s Disparities in Mental Health Services Research Program. This introduction provides an overview of the special issue that contains current research, projects, and programs that address disparities. The articles range from literature reviews to original research and focus on a variety of historically underrepresented populations.

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Section: Literature Reviewsmentioning

confidence: 99%

Introduction to the special issue: Improving access and quality of mental health care for diverse populations.

Iwamasa¹,

Gray²,

Klee³

2023

Psychological Services

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“…Recently, increased efforts have focused on identifying trends in suicide rates by subgroups, including by race and ethnicity [8,9], to help guide tailored prevention efforts. Against the backdrop of findings which suggested a decrease in the overall general United States population 2019 suicide rate, Ramchand et al conducted a cross-sectional study to examine trends in suicide rates among United States racial and ethnic groups [8].…”

Section: Introductionmentioning

confidence: 99%

“…A recent analysis undertaken to explore trends among AI/AN veterans provides further support for these assertions. Mohatt et al conducted a retrospective cohort analysis of AI/AN individuals who received care within the Veterans Health Administration between 2002 and 2014 and found that the age-adjusted suicide rates more than doubled over the 15-year observation period (19.1-47.0/100,000 Person Years) [9]. Also of note, was the finding that the youngest age group (18-39) exhibited the highest risk [9].…”

Section: Introductionmentioning

confidence: 99%

“…Mohatt et al conducted a retrospective cohort analysis of AI/AN individuals who received care within the Veterans Health Administration between 2002 and 2014 and found that the age-adjusted suicide rates more than doubled over the 15-year observation period (19.1-47.0/100,000 Person Years) [9]. Also of note, was the finding that the youngest age group (18-39) exhibited the highest risk [9]. Taken together, these findings suggest that investigation into suicide rates among racialized minorities with current or past military service should consider if rates and trends vary within subgroups by age group.…”

Section: Introductionmentioning

confidence: 99%

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Trends in suicide rates by race and ethnicity among members of the United States Army

et al. 2023

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Efforts were focused on identifying differences in suicide rates and time-dependent hazard rate trends, overall and within age groups, by race and ethnicity among United States Army members who returned from an index deployment (October 2007 to September 2014). This retrospective cohort study was conducted using an existing longitudinal database, the Substance Use and Psychological Injury Combat Study (SUPIC). Demographic (e.g., race and ethnicity) and military data from the Department of Defense compiled within SUPIC, as well as Department of Veterans Affairs data were linked with National Death Index records (through 2018) to identify deaths by suicide including those that occurred after military service. The cohort included 860,930 Army Service members (Active Duty, National Guard, and Reserve). Age-adjusted (using the direct standardization method) and age-specific suicide rates per 100,000 person years were calculated and rate ratios (RR) were used for comparisons. Trends were evaluated using hazard rates over time since the end of individuals’ index deployments. Among those aged 18–29 at the end of their index deployment, the suicide rate for American Indian/Alaskan Native (AI/AN) individuals was 1.51 times higher (95% confidence interval [CI]: 1.03, 2.14) compared to White non-Hispanic individuals (WNH), and lower for Hispanic and Black non-Hispanic (BNH) than for WNH individuals (RR = 0.65 [95% CI: 0.55, 0.77] and RR = 0.71 [95% CI: 0.61, 0.82], respectively). However, analyses revealed increasing trends in hazard rates post-deployment (≤ 6.5 years) within groups of Hispanic and BNH individuals (Average Annual Percent Change [APC]: 12.1% [95% CI: 1.3%, 24.1%] and 11.4% [95% CI: 6.9%, 16.0%], respectively) with a smaller, increase for WNH individuals (APC: 3.1%; 95% CI: 0.1%, 6.1%). Findings highlight key subgroups at risk for post-deployment suicide (i.e., WNH, AI/AN and younger individuals), as well as heterogeneous trends overtime, with rates and trends varying within race and ethnic groups by age groups. Post-deployment suicide prevention efforts that address culturally relevant factors and social determinants of health associated with health inequities are needed.

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“…Department of Veterans Affairs, 2020). Among AI/AN veterans who use U.S. Veterans Health Administration care suicide rates increased 146% from 2004 to 2018 (19.1–47.0 per 100,000; Mohatt et al, in press).…”

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confidence: 99%

A scoping review of veteran suicide prevention programs in Native American communities and in the general population.

Mohatt

Begay

Goss

et al. 2023

Psychological Services

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Suicide is a major public health problem that disproportionately impacts veterans in the general U.S. population. Recent analyses indicate that American Indian and Alaska Native (AI/AN) veterans may be two to three times as likely as non-Hispanic White veterans to experience suicidal ideation. Although suicide prevention programs have been successfully implemented for many at-risk populations, to our knowledge, none have been designed or implemented for AI/AN veterans. To address this gap, we conducted a scoping review of suicide prevention programs with the objective of identifying promising strategies and lessons learned to identify promising practices for preventing suicide among AI/AN veterans. We conducted two parallel literature searches-a review of suicide prevention programs for the general U.S. adult population and AI/AN communities. We rated programs on 16 criteria, covering five domains-best practices in suicide prevention, U.S. Department of Veterans Affairs (VA) Office of Rural Health Promising Practice criteria, cultural fit, care coordination, and outcomes. Our findings indicate that many of the VA evidencebased or best practice programs are available system-wide, but none have been tailored for AI/AN veterans or the communities in which they live. Conversely, we found that many culturally specific programs implemented in AI/AN communities were rarely disseminated beyond tribal land and none were specifically developed for veterans. Based upon these findings, and to advance suicide prevention programs for AI/AN veterans, we propose a suicide prevention model that builds upon existing VA infrastructure to disseminate best practices to AI/AN communities and integrate tribal-specific cultural approaches to suicide prevention. Impact StatementAmerican Indian and Alaska Native (AI/ANs) Veterans are at higher risk of suicide than other Veterans, yet no suicide prevention programs exist that have been developed for this group. Given that AI/ANs also serve in the military at higher rates than any other race/ethnic group, it is critical to develop and deliver suicide prevention programs and services targeting AI/AN Veterans that are culturally acceptable and effective.

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Suicide Among American Indian and Alaska Native Veterans Who Use Veterans Health Administration Care

Cited by 10 publications

References 18 publications

Introduction to the special issue: Improving access and quality of mental health care for diverse populations.

Introduction to the special issue: Improving access and quality of mental health care for diverse populations.

Trends in suicide rates by race and ethnicity among members of the United States Army

A scoping review of veteran suicide prevention programs in Native American communities and in the general population.

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