Cohort study of longitudinal risk for suicidal self-directed violence among veterans with cancer

Patients with cancer experience significantly higher rates of suicidal self-directed violence (SSDV; both fatal and nonfatal suicide attempts) compared with the general population. A cohort study among veterans with cancer aimed to assesslongitudinal risks and methods for SSDV and identify associated risk factors to improve screening and prevention strategies. Among 292 271 veterans with cancer between 2014 and 2023 (mean age 69.0 ± 9.4 years; 98% male) there were 2400 SSDV events (1%; overall rate 203 per 100 000 person years). The most common method used was poisoning (26%). Estimated SSDV probabilities were highest for those with cancers of the central nervous system, pancreas, head and neck, liver and biliary system, and thyroid. Veterans with severe frailty, advanced cancer, chronic mental illness, and high pain scores had high SSDV rates compared with the overall cohort. Veteran subgroups including those of younger age (≤ 45 years), female sex, American Indian or Alaska Native race, and those with thyroid cancer had high rates of nonfatal attempts. The risk persisted 5 years postdiagnosis for those who were younger, unmarried, or had central nervous system cancer. The authors conclude that many veteran subgroups at risk for SSDV are overlooked, limiting opportunities for intervention.