Can services to address Veterans social determinants of health reduce their suicide risk?

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Background: Despite accessible and effective suicide prevention strategies offered by the Veterans Health Administration (VHA), Veteran suicide remains elevated compared to the general US population, indicating a continued need to identify Veterans at risk for suicide and provide interventions to prevent suicide. Suicide prevention can be enhanced when health care systems integrate dynamic social determinants of health (SDH), such as housing instability, justice involvement, and unemployment. Significance/Impact: The goal of this HSR&D Veteran Suicide Prevention project is to address prevention activities that occur “upstream” by examining how services addressing SDH may also prevent suicide among Veterans, key objectives in the VA’s National Strategy for Preventing Veteran Suicide 2018–2028. Innovation: This study will integrate a public health perspective to suicide prevention through a lens of SDH. Rather than focusing specifically on medical intervention, this study will explore—based both on a natural experimental design using existing administrative data and on gathering the perspectives of key informants and Veterans—how addressing SDH can decrease suicide risk, taking into account the complex needs of Veterans who may be at risk for suicide. Specific Aims: This study aims to determine whether VHA services tailored to address SDH may also have an added benefit of preventing suicide mortality; identify organizational assets and opportunities to improve how SDH-focused services address suicide risk among Veterans; and engage Veterans in identifying ways to integrate suicide prevention into VHA programs that respond to SDH. Methodology: The proposed research is a concurrent mixed methods design. Retrospective quantitative analyses will examine how VHA services tailored to Veterans’ SDH (i.e., housing instability, justice involvement, unemployment) may protect against suicide mortality and morbidity. A mixed methods environmental scan will include a questionnaire of staff/key informants and qualitative interviews. Qualitative interviews with Veterans with a history of suicide risk will explore how services to address SDH respond to those needs. Implementation/Next Steps: This project will lead to actionable implementation projects: increased linkages to services for SDH among Veterans with histories of suicidal crisis as well as enhanced training for providers to integrate suicide prevention into services addressing SDH, and vice versa. We have convened an array of VA operations partners—Social Work, VHA Homeless and Justice Programs, employment programs, and VA Office of Mental Health and Suicide Prevention—to facilitate removing siloes around SDH and suicide prevention in VA, amplifying VA’s current infrastructure to bolster suicide prevention.