Suicide among Veterans receiving Veterans Health Administration Home Based Primary Care and following discharge from Community Living Centers

Abstract

Introduction: Veterans who receive Veterans Health Administration (VHA) Home Based Primary Care (HBPC) services and those discharged from VHA Community Living Centers (CLC) may be at increased risk of suicide. No studies to date have assessed suicide risks among HBPC patients. This study examined suicide risks among recipients of VHA HBPC services and following discharge from VHA CLCs, as compared to other Veteran VHA users. Methods: We identified three cohorts of 2013 Veteran VHA patients: 47,842 HBPC users, 17,725 with live discharges from CLCs, and 5,554,635 other VHA users. Using proportional hazards regression, we assessed risk of suicide through 2016. Results: Overall, HBPC recipients did not differ from the other cohorts in suicide risk. Although in unadjusted analyses CLC discharged patients had greater suicide risk than the general VHA patient cohort (hazard ratio (HR) = 1.73, 95% confidence interval = 1.25-2.41), this became nonsignificant when controlling for diagnoses. Conclusions: Overall findings did not identify differential suicide risk among VHA HBPC recipients in 2013, when compared to other Veteran VHA patient cohorts.Veterans discharged from VHA CLCs have increased mental health morbidity, which was associated with increased suicide risk.

Home-based primary care–mental health integration in the Veterans Health Administration: An updated evaluation of practice patterns.

“…Nonetheless, examining administrative data regarding types of mental health services provided to veterans with what types of concerns, and comparing this information across programs, may help to paint a clearer picture of the impact of mental health integration in HBPC. Continuing to understand the needs of veterans at risk for suicide (Cooper et al, 2021) or serious mental illness in HBPC, and models for managing their care, is important. Moreover, as alluded to above, while a significant increase in telehealth services was initially a response to the COVID-19 pandemic, future evaluation efforts, including surveys of HBPC MH providers, should focus on the extent to which increased use of telehealth services is sustained in practice and its impact on care access and outcomes.…”