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Time Trends and Predictors of Suicide Among Mental Health Outpatients in the Department of Veterans Affairs

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Abstract

Using merged Veterans Affairs (VA) and National Death Index data, this study examined changes in suicide rate among three cohorts of VA mental health outpatients during a time of extensive bed closures and system-wide reorganization (1995, N = 76,105; 1997, N = 81,512; and 2001, N = 102,184). There was a decreasing but nonsignificant trend in suicide rates over time—13.2, 11.4, and 10.3 per 10,000 person-years, respectively. Multivariable predictors of suicide included both younger and older ages (U-shaped association). At the facility level, there was an association between greater per capita outpatient mental health expenditure and reduced suicide risk. The model also showed a protective effect associated with increased mental health spending on inpatient services, and that outpatients at facilities with larger mental health programs, as measured by patient volume, were at greater risk for suicide than were those in smaller programs. Although more chronic patients may have been underrepresented to some extent as a result of the sampling methodology, these findings provide generally reassuring evidence that overall suicide rates have not been adversely affected by VA system changes. Nevertheless, they highlight the importance of funding for mental health services as well as the implications of changing demographics in the VA population.

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Acknowledgments

The design and analysis of this study was supported in part by grants IIR 20-043-1 (Dr. R. A. Desai) and MRP 02-259-2 (Career Development Award to Dr. M. M. Desai) from the VA Health Services Research and Development Service. The views expressed in this article are those of the authors and do not necessarily represent the position or policy of the Department of Veterans Affairs.

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Authors and Affiliations

  1. New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, NEPEC (182), 950 Campbell Avenue, West Haven, CT, 06516, USA

    Mayur M. Desai PhD, MPH, Robert A. Rosenheck MD & Rani A. Desai PhD, MPH

  2. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

    Mayur M. Desai PhD, MPH, Robert A. Rosenheck MD & Rani A. Desai PhD, MPH

  3. Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA

    Mayur M. Desai PhD, MPH, Robert A. Rosenheck MD & Rani A. Desai PhD, MPH

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  1. Mayur M. Desai PhD, MPH
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  2. Robert A. Rosenheck MD
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  3. Rani A. Desai PhD, MPH
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Correspondence to Mayur M. Desai PhD, MPH.

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Desai, M.M., Rosenheck, R.A. & Desai, R.A. Time Trends and Predictors of Suicide Among Mental Health Outpatients in the Department of Veterans Affairs. J Behav Health Serv Res 35, 115–124 (2008). https://doi.org/10.1007/s11414-007-9092-0

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  • DOI: https://doi.org/10.1007/s11414-007-9092-0

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