{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T05:41:04Z","timestamp":1741153264280,"version":"3.38.0"},"reference-count":71,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>US veterans have a higher risk of suicide than the general civilian population. Research suggests that COVID-19 infection is associated with increased risk of suicide attempts or other forms of self-directed violence (SDV) among veterans.<\/jats:p><\/jats:sec>Objective<\/jats:title>To identify subgroups of veterans with high risk of post\u2013COVID-19 suicide attempts or SDV.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This is a retrospective cohort study conducted using data from the Veteran Health Administration (VHA). Participants included VHA enrollees with a first case of COVID-19 between May 1, 2021, and April 30, 2022, residing in the 50 states or Washington, DC.<\/jats:p><\/jats:sec>Exposure<\/jats:title>COVID-19 infection.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The main outcome was a suicide attempt or SDV 12 months after COVID-19 infection. Latent class analysis was used to identify subgroups. Outcome rates and 95% CIs per 10\u202f000 veterans were calculated. Multinomial regressions were used to model outcome risk and marginal risk ratios with 99.5% CIs to compare outcome risk across latent classes.<\/jats:p><\/jats:sec>Results<\/jats:title>The cohort included 285\u202f235 veterans with COVID-19 and was predominantly male (248\u202f118 veterans [87.0%]) and younger than 65 years (171\u202f636 veterans [60.2%]). Chronic pain (152\u202f788 veterans [53.6%]), depression (98\u202f093 veterans [34.4%]), and posttraumatic stress disorder (79\u202f462 veterans [27.9%]) diagnoses were common. The 12-month outcome rate was 73.8 events per 10\u202f000 (95% CI, 70.7-77.0 events per 10\u202f000). Two latent classes with high rates of suicide attempt or SDV were identified. The first high-risk subgroup (46\u202f693 veterans [16.4%]) was older (34\u202f472 veterans [73.8%]\u2009aged \u226565 years) and had a high prevalence of physical conditions (43\u202f329 veterans [92.8%] had hypertension, and 36\u202f824 veterans [78.9%] had chronic pain); the 12-month outcome rate was 103.7 events per 10\u202f000 (95% CI, 94.7-113.3 events per 10\u202f000). The second high-risk subgroup (82\u202f309 veterans [28.9%]) was generally younger (68\u202f822 veterans [83.6%]\u2009aged &amp;lt;65 years) with a lower prevalence of physical conditions but high prevalence of mental health conditions (61\u202f367 veterans [74.6%] had depression, and 50\u202f073 veterans [60.8%] had posttraumatic stress disorder); the 12-month outcome rate was 162.9 events per 10\u202f000 (95% CI, 154.5-171.8 events per 10\u202f000), and compared with the lowest risk subgroup, the 12-month risk of suicide attempts or SDV was 14 times higher in this subgroup (risk ratio, 14.23; 99.5% CI, 10.22-19.80).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of veterans with COVID-19, 2 veteran subgroups with distinct health profiles had high rates of suicide attempts and SDV, suggesting that different groups may require different approaches to suicide prevention after COVID-19.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.0061","type":"journal-article","created":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T16:30:34Z","timestamp":1741105834000},"page":"e250061","source":"Crossref","is-referenced-by-count":0,"title":["Veterans at High Risk for Post\u2013COVID-19 Suicide Attempts or Other Self-Directed Violence"],"prefix":"10.1001","volume":"8","author":[{"given":"David P.","family":"Bui","sequence":"first","affiliation":[{"name":"Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meike","family":"Niederhausen","sequence":"additional","affiliation":[{"name":"Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon"},{"name":"Portland State University School of Public Health, Oregon Health & Science University, 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