High suicide rates in American Indian/Alaska Native veterans

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Rates of suicide among American Indian/Alaska Native (AI/AN) veterans have risen sharply in recent years, reports a study in the April issue of Medical Care.

Age-adjusted rates among AI/AN receiving care in the Veterans Health Administration (VHA) system increased by nearly 150% over the previous two decades, according to the new research by Nathaniel Mohatt, Ph.D., of Veteran's Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, Colo., and colleagues. "Our results suggest a compelling need to review and strengthen suicide prevention efforts for AI/AN veterans," the researchers write.

Suicide 'an increasing problem' in AI/AN veterans—Especially at younger ages

The researchers analyzed suicide rates among AI/AN veterans who received provided or paid for by the VHA between 2002 and 2014, with follow-up through 2018. The analysis included veterans classified as single-race (about two-thirds) or multi-race AI/AN, regardless of their place of residence (including tribal or non-tribal communities).

During the period studied, suicide rates among AI/AN veterans more than doubled: from 19.1 to 47.0 per 100,000 person-years, after adjustment for age. Suicide rate was highest in the youngest age group, aged 18 to 39 years: 66.0 per 100,000 person-years. That compared to rates of 36.9 per 100,000 in among AI/AN veterans aged 40 to 59 years and 27.3 per 100,000 in those aged 60 or older.

The youngest age group also had the fastest growth in suicides: from less than 10 deaths between 2004 and 2008 to 52 deaths between 2014 to 2018. The most frequently used lethal means was firearms, accounting for nearly 60% of suicide deaths. Older AI/AN veterans were most likely to die by firearm.

Compared to other Veteran's Affairs (VA) data, the findings suggest that suicide rates may have increased more rapidly among AI/AN veterans over a similar time period, compared to the general population of veterans: by 146 versus 32%. The rising suicide rate among younger AI/AN veterans is consistent with trends among all veterans, as well as in the general AI/AN population.

With high rates of suicide among US veterans, the VA has made suicide prevention its "top clinical priority," including targeting of racial and other groups of veterans at high risk. American Indian and Alaska Natives in the general population have the highest rates of suicide of all US , as well as the fastest-growing suicide rates.

The study provides "a first look at AI/AN VHA- suicide rates by age group," according to the authors. Repeating the analysis among all veterans, regardless of whether they receive VHA care, will be a "critical next step" in assessing among AI/AN veterans compared to other racial/ethnic groups.

"When considering suicide disparities experienced by AI/AN people, it is critical to acknowledge the role of historical trauma and persistent structural inequities in creating and maintaining the disparity," Dr. Mohatt and colleagues add. "Reducing suicide deaths among AI/AN veterans will require careful attention to culture-specific risk and protective factors and tailoring VHA suicide prevention to meet the needs of AI/AN veterans and their communities."

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More information: Nathaniel V. Mohatt et al, Suicide Among American Indian and Alaska Native Veterans Who Use Veterans Health Administration Care, Medical Care (2022). DOI: 10.1097/MLR.0000000000001656
Journal information: Medical Care

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