John R. Blosnich|Ann Elizabeth Montgomery|Melissa E. Dichter|Adam J. Gordon|Dio Kavalieratos|Laura D. Taylor|Bryan Ketterer|Robert M. Bossarte
Social Determinants and Military Veterans’ Suicide Ideation and Attempt: a Cross-sectional Analysis of Electronic Health Record Data
VA Pittsburgh Healthcare System|United States Department of Veterans Affairs|Philadelphia VA Medical Center|VA Salt Lake City Healthcare System|University of Pittsburgh|United States Department of Veterans Affairs|Veterans Health Administration|Canandaigua VA Medical Center|Canandaigua VA Medical Center
health care systems struggle identify risk factors suicide adverse social determinants health sdh strong predictors suicide risk electronic health records ehr include sdh data determine prevalence sdh documentation ehr sdh associated suicide ideation attempt crosssectional analysis included ehr data spanning october 1 2015september 30 2016 veterans integrated service network region 4 study included patients least one inpatient outpatient visit n 293872 adverse sdh operationalized using veterans health administration vha coding services international statistical classification diseases related health problems icd10 codes encompassed seven types violence housing instability financialemployment problems legal problems familialsocial problems lack access caretransportation nonspecific psychosocial needs defined suicide morbidity icd10 codes data vhas suicide prevention applications network logistic regression assessed associations sdh suicide morbidity adjusting sociodemographics mental health diagnoses eg major depression statistical significance assessed p 01 overall 164 patients least one adverse sdh indicator adverse sdh exhibited doseresponselike associations suicidal ideation suicide attempt additional adverse sdh increased odds suicidal ideation 67 aor 167 99ci 160175 p 01 suicide attempt 49 aor 149 99ci 133168 p 01 independently adverse sdh strong effect sizes ranging 186 99ci 158219 p 01 legal issues 310 99ci 274350 p 01 nonspecific psychosocial needs models assessing suicidal ideation 158 99ci 110227 p 01 employmentfinancial problems 290 99ci 230416 p 01 violence models assessing suicide attempt sdh strongly associated suicidal ideation suicide attempt even adjusting mental health diagnoses integration sdh data ehr could improve suicide prevention