Comorbidity profiles in older patients last seen by mental health prior to suicide attempt.

OBJECTIVES: Suicide in late life is a public health concern. Determining profiles of psychiatric/medical comorbidity in those who attempt while engaged in mental health services may assist with prevention. We identified comorbidity profiles and their association with utilization, means, and fatality in a national sample who attempted suicide. METHODS: Using latent class analysis, all patients aged ≥ 65 from the Department of Veterans Affairs (VA) healthcare services (2012-2018) last seen in mental health prior to suicide attempt were included. Diagnoses and attempt data were obtained from VA and Center for Medicare & Medicaid Services, VA Suicide Prevention Applications Network, and VA National Mortality Data Repository. RESULTS: 2,269 patients were clustered into three profiles, all with high probability of depression. Profiles included minimal comorbidity (50.4%), high medical comorbidity (28.6%), and high (psychiatric/medical) comorbidity (21.0%). Over half (61.7%) attempted suicide within one week of their visit. The class with highest comorbidity had lowest proportion of fatal attempts, while minimal comorbidity class had highest proportion. CONCLUSIONS: Older patients last seen in mental health prior to suicide attempt were characterized by depression and varying additional comorbidity and attempt-related factors. Findings have implications for risk assessment and intervention in mental health settings, beyond depression.

Veteran Suicide: Missed Opportunities for Suicide Prevention Within Concealed Pistol License Curriculum.

INTRODUCTION: Veteran suicide is a growing topic for public health concern. Despite enhancements from the Department of Veterans Health Administration, clinicians continue to struggle to identify and engage veterans at risk for suicide. MATERIALS AND METHODS: Examining suicide prevention efforts, epidemiology, risk factors, and barriers to care; Substance Abuse and Mental Health Services Administration and the U.S. Department of Veterans Affairs Governor's Challenges identified lethal means as one of 3 priority areas to focus on in during this agenda. RESULTS: The writers identified gaps within the current literature as an area for future research on lethal means within the veteran population and opportunity for intervention with concealed pistol license curriculum. CONCLUSION: This article ends with recommendations for further research on veteran suicides, acquisition of concealed pistol licenses, and advocacy for legislative change to require suicide prevention resources and education to be included in the training curriculum for concealed pistol license holders.