VHA Care Use and Suicide Risk Among Veterans After Military Separation

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This cohort study included 649,811 Army veterans who separated from service by September 2017 and were followed for suicide deaths through December 2018.
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The age-adjusted annual suicide rate was 28.77 per 100,000 person-years among VHA users and 35.92 among nonusers (rate ratio, 0.80; 95% CI, 0.68-0.94).
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Nonusers had higher time-dependent suicide hazard rates during the first 2 years after separation; rates did not differ in year 3 or after year 4, except for higher rates among users in year 4.
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Among VHA users, those initiating care within 12 months had higher early suicide hazard-rate estimates than those whose first use occurred later, although estimates for delayed users rose over time.
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First-year VHA inpatient care was associated with markedly higher suicide hazard-rate estimates in later follow-up, and the authors noted that selection bias and residual confounding limit interpretat

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