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Letters   |    
Age and Suicide Among Veterans With a History of Homelessness
Robert M. Bossarte, Ph.D.; Rebecca Piegari, M.S.; Lindsay Hill; Vincent Kane, M.S.W.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201300128
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The authors are affiliated with the National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs (VA), Philadelphia. Dr. Bossarte and Ms. Piegari are also with the VA Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York.

Copyright © 2013 by the American Psychiatric Association

To the Editor: Existing data suggest that suicide rates increase during middle age and again among older adults in the general population (1). Previous research has documented more than a fourfold increase in risk for all-cause and cause-specific mortality associated with homelessness (2). However, less is known about the relationships between suicide and age among those with history of homelessness. In recent years, identifying risk factors and intervention strategies to eliminate homelessness among veterans has become a national priority (3). Understanding age-related variability among veterans who have died from suicide will increase understanding of differences in mortality associated with homelessness and opportunities for prevention.

Using data from the 2000–2008 fiscal years, we identified age-based differences in suicide among veterans with and without a history of homelessness. Deaths from suicide were identified by using data from Veterans Health Administration (VHA) administrative records linked with data on cause of death from the National Death Index (4). History of homelessness was defined as one or more intake assessments conducted by VHA case managers once a veteran was identified as homeless or at risk of homelessness. During the project period, a total of 15,535 suicides occurred and 238,266 unique VHA patients were assessed for homeless services. Among the veterans who died by suicide, 561 (3.6%) had a history of homelessness.

The distribution of suicides among those without a history of homelessness was bimodal, with higher prevalence during middle age and again among older adults. In contrast, suicides among homeless veterans had a single peak during middle age. [Figures illustrating these patterns are available online as a data supplement to this letter.] Comparisons of average age at time of death confirmed these differences. The difference in average age at death was statistically significant: 48.5 years among veterans with a history of homelessness and 60.8 years among those without a history of homelessness (t=31.61, df=701, p<.001).

Results from this project support recommendations for routine assessment of housing status and awareness of age-related differences in mortality associated with homelessness. It is unclear whether the observed patterns are related to population differences in suicide risk, variability in assessment and service use, cohort-specific exposures, or changes in housing associated with increasing age. Additional research on the relationships between homelessness, suicide risk, and age is recommended.

The authors report no competing interests.

CDC Wonder Online Database: Underlying Cause of Death 1999–2009. Atlanta, Centers for Disease Control and Prevention, 2012. Available at wonder.cdc.gov/ucd-icd10.html. Accessed May 24, 2012
 
Morrison  DS:  Homelessness as an independent risk factor for mortality: results from a retrospective cohort study.  International Journal of Epidemiology 38:877–883, 2009
[CrossRef] | [PubMed]
 
Opening Doors: Federal Strategic Plan to Prevent and End Homelessness. Washington, DC, United States Interagency Council on Homelessness, 2010. Available at www.usich.gov/opening_doors
 
Blow  FC;  Bohnert  A;  Ilgen  M  et al:  Suicide mortality among patients treated by the Veterans Health Administration from 2000 to 2007.  American Journal of Public Health 102(suppl 1):S98–S104, 2012
[CrossRef] | [PubMed]
 
References Container
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References

CDC Wonder Online Database: Underlying Cause of Death 1999–2009. Atlanta, Centers for Disease Control and Prevention, 2012. Available at wonder.cdc.gov/ucd-icd10.html. Accessed May 24, 2012
 
Morrison  DS:  Homelessness as an independent risk factor for mortality: results from a retrospective cohort study.  International Journal of Epidemiology 38:877–883, 2009
[CrossRef] | [PubMed]
 
Opening Doors: Federal Strategic Plan to Prevent and End Homelessness. Washington, DC, United States Interagency Council on Homelessness, 2010. Available at www.usich.gov/opening_doors
 
Blow  FC;  Bohnert  A;  Ilgen  M  et al:  Suicide mortality among patients treated by the Veterans Health Administration from 2000 to 2007.  American Journal of Public Health 102(suppl 1):S98–S104, 2012
[CrossRef] | [PubMed]
 
References Container
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