Veterans at risk of suicide who do not list a contact for emergencies when creating a safety plan may be more likely to attempt or die by suicide within a year than those who list a contact, according to a report in Psychiatric Services. The study found that these veterans are also more likely to be hospitalized.
“Although it was unclear why these contacts were missing, the lack of social contacts on safety plans may be a potential indicator for future suicide risk and may serve as a marker of other suicide risk factors (such as lack of belonging and isolation),” wrote Samantha Chalker, Ph.D., of the University of California, San Diego, and colleagues.
Safety planning is a suicide prevention intervention that relies partly on an individual’s social relationships, including a “distraction contact” for when the at-risk individual needs to be distracted from isolation or from suicidal thoughts and a “help contact” to turn to in a suicidal crisis.
Chalker and colleagues examined data on 1,602 veterans who completed a safety plan between October 1, 2018, and July 8, 2020, using the U.S. Department of Veterans Affairs San Diego Healthcare System’s electronic medical record system. The researchers specifically focused on whether the safety plans listed distraction and/or help contacts, as well as recorded suicide attempts, suicide deaths, and use of crisis services (including inpatient psychiatric hospitalization admissions and emergency department visits) within one year of creating a safety plan.
They found that 20% of veterans who completed a safety plan (n=320) did not have a distraction contact and 10% (n=161) did not have a help contact; of this group, 105 veterans did not have a person listed in either category.
Within the 12 months following completion of a suicide safety plan, 6% of the veterans in the sample made at least one suicide attempt or died by suicide, 8% had at least one psychiatric inpatient hospitalization, and 15% had at least one emergency department visit. Veterans without a help contact in their safety plan were 2.11 times more likely to attempt suicide or die by suicide within a year than were veterans with a help contact. Similarly, veterans who did not list either a distraction or a help contact were 2.45 times more likely to make a suicide attempt or die by suicide in the next year than were veterans with both distraction and help contacts.
Veterans without a help contact were also 1.9 times more likely to have a psychiatric inpatient hospitalization than were veterans with a help contact and 1.88 times more likely to be admitted to the emergency department. Veterans who did not report a distraction contact did not show any increased use of crisis services, however.
“This study reaffirms the importance of quality and completeness when creating effective safety plans,” the researchers wrote. “Its findings also suggest that the lack of social contacts on safety plans may be an important target for future suicide prevention interventions.”
For related information, see the Psychiatric News article “Upping Our Game to Prevent Suicide.”