The following is a summary of “Association of Frailty With Risk of Suicide Attempt in a National Cohort of US Veterans Aged 65 Years or Older,” published in the February 2023 issue of Psychiatry by Kuffel, et al.

For the cohort study, conducted from October 1, 2011, to September 30, 2013, researchers integrated databases from the US Department of Veterans Affairs (VA) inpatient and outpatient health care services, Centers for Medicare & Medicaid Services data, and national suicide data. It included all US veterans aged 65 or older who received care at VA medical centers. The data were analyzed from April 20, 2021, to May 31, 2022.

Frailty, as defined by a validated cumulative-deficit frailty index using electronic health data, was categorized into five levels: non-frailty, prefrailty, mild frailty, moderate frailty, and severe frailty. The study population of 2,858,876 participants included 8,955 (0.3%) who attempted suicide over six years.

Compared with patients without frailty, the risk of suicide attempt was uniformly higher among patients with prefrailty to severe frailty. The adjusted hazard ratios (aHRs) were 1.34 (95% CI, 1.27-1.42; P < .001) for prefrailty, 1.44 (95% CI, 1.35-1.54; P < .001) for mild frailty, 1.48 (95% CI, 1.36-1.60; P < .001) for moderate frailty, and 1.42 (95% CI, 1.29-1.56; P < .001) for severe frailty. Lower levels of frailty were associated with a greater risk of lethal suicide attempt, with an aHR of 1.20 (95% CI, 1.12-1.28) for prefrail veterans. Bipolar disorder (aHR, 2.69; 95% CI, 2.54-2.86), depression (aHR, 1.78; 95% CI, 1.67-1.87), anxiety (aHR, 1.36; 95% CI, 1.28-1.45), chronic pain (aHR, 1.22; 95% CI, 1.15-1.29), use of durable medical equipment (aHR, 1.14; 95% CI, 1.03-1.25), and lung disease (aHR, 1.11; 95% CI, 1.06-1.17) were independently associated with an increased risk of a suicide attempt. The study population had a mean (SD) age of 75.4 (8.1) years, and 97.7% were men. Of the total population, 2.3% were women, 0.6% were Hispanic, 9.0% were non-Hispanic Black, 87.8% were non-Hispanic White, and 2.6% had other or unknown race and ethnicity. 

The study concluded that screening and involvement of supportive services across the spectrum of frailty are needed to help reduce the risk of suicide attempts among US veterans aged 65 years or older.

Source: jamanetwork.com/journals/jamapsychiatry/article-abstract/2801904