Lethal means among Veterans with recent experience of housing instability by age

Abstract: Background: U.S. military Veterans have a higher suicide rate than the general population, with the U.S. Department of Veterans Affairs (VA) identifying suicide prevention as a clinical priority. Veterans experiencing housing instability are at even greater risk, yet specific details regarding their suicide mortality, including age-related patterns and methods used, remain underexamined. Methods: This cross-sectional study analyzed a cohort of 662,682 Veterans with an indicator of housing instability recorded in their VA Electronic Health Record between January 1, 2014, and December 31, 2018. Data were obtained from the Corporate Data Warehouse and the Homeless Management Information System. Suicide mortality was determined using the VA's Mortality Data Repository and National Death Index records, tracking deaths for up to two years after the initial record of housing instability. Results: Among the cohort, 2,078 (0.31%) Veterans died by suicide. Suicide rates were highest among Veterans aged 35–44 (131 suicides per 100,000 person-years) and lowest among those aged 54–65 (62 suicides per 100,000 person-years). Firearms were the most prevalent means of suicide, though usage varied significantly by age (p<0.001). Older Veterans (65+) were more likely to use firearms (67.1%) compared to younger Veterans (49.3%). Conclusions: This study provides the first detailed epidemiological analysis of suicide among Veterans with housing instability, highlighting the intersection of age and lethal means. Given the high prevalence of firearm use, future interventions should prioritize lethal means safety, including the distribution of free secure firearm storage devices and counseling on firearm safety, to reduce suicide risk in this vulnerable population.