Suicide Following Stroke in the United States Veterans Health Administration Population

To evaluate risk for suicide among Veterans with a history of stroke, seeking care within the Veterans Health Administration (VHA), we analyzed existing clinical data. This retrospective cohort study was approved and performed in accordance with the local Institutional Review Board. Veterans were identified via the VHA's Corporate Data Warehouse (CDW). Initial eligibility criteria included confirmed Veteran status and at least 90 days of VHA utilization between fiscal years 2001-2015. Cox proportional hazards models were used to assess the association between history of stroke and suicide. Among those Veterans who died by suicide, the association between history of stroke and method of suicide was also investigated. VHA PARTICIPANTS: Veteran's with at least 90 days of VHA utilization between fiscal years 2001-2015 INTERVENTIONS: not applicable MAIN OUTCOME MEASURE(S): suicide and method of suicide RESULTS: Data from 1,647,671 Veterans were analyzed (1,405,762 without stroke and 241,909 with stroke). The fully adjusted model, which controlled for age, sex, mental health diagnoses, mild traumatic brain injury (TBI), and modified Charlson/Deyo Index (stroke-related diagnoses excluded), demonstrated a hazard ratio of 1.13 (95% CI: 1.02-1.25; p = 0.02). The majority of suicides in both cohorts was by firearm, and a significantly larger proportion of suicides occurred by firearm in the group with stroke compared to the cohort without (81.2% versus 76.6%). Findings suggest that Veterans with a history of stroke are at increased risk for suicide, specifically by firearm, compared to Veterans without a history of stroke. Increased efforts are needed to address the mental health needs and lethal means safety of Veterans with a history of stroke, with the goal of improving function and decreasing negative psychiatric outcomes, such as suicide.