Abstract
Objective
Research examining social determinants of suicide risk in veterans suggests a potential link between food insecurity and subsequent suicidal ideation in military veterans. The objective of this study is to investigate, if and how, food insecurity predicts subsequent suicidal ideation in a nationally representative longitudinal survey of veterans.
Methods
A national longitudinal survey was analyzed of participants randomly drawn from over one million U.S. military service members who served after September 11, 2001. N = 1,090 veterans provided two waves of data one year apart (79% retention rate); the final sample was representative of post-9/11 veterans in all 50 states and all military branches.
Results
Veterans with food insecurity had nearly four times higher suicidal ideation one year later compared to veterans not reporting food insecurity (39% vs 10%). In multivariable analyses controlling for demographic, military, and clinical covariates, food insecurity (OR = 2.37, p =.0165) predicted suicidal ideation one year later, as did mental health disorders (OR = 2.12, p = .0097). Veterans with both food insecurity and mental health disorders had a more than nine-fold increase in predicted probability of suicidal ideation in the subsequent year compared to veterans with neither food insecurity nor mental health disorders (48.5% vs. 5.5%).
Conclusion
These findings identify food insecurity as an independent risk marker for suicidal ideation in military veterans in addition to mental disorders. Food insecurity is both an indicator of and an intervention point for subsequent suicide risk. Regularly assessing for food insecurity, and intervening accordingly, can provide upstream opportunities to reduce odds of suicide among veterans.
HIGHLIGHTS
Military veterans with food insecurity were at elevated risk of suicidal ideation.
Veterans with mental health disorders had higher odds of suicidal ideation one year later.
Food insecurity plus mental health disorders led to a substantial increase in suicidal ideation.
ACKNOWLEDGMENTS
We would like to extend our sincere thanks to those who volunteered for this study. The second and third authors, both funded through the Department of Veterans Affairs Psychosocial Rehabilitation and Recovery Fellowship, made equal contributions to this manuscript and are listed in alphabetical order. The views expressed in this article are those of the authors and do not necessarily represent the views of the National Institutes of Health or the Department of Veteran Affairs.
Additional information
Funding
Notes on contributors
Eric B. Elbogen
Eric B. Elbogen, PhD, Veterans Health Administration, National Center on Homelessness among Veterans, Tampa, FL, USA; Durham VA Healthcare System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Robert C. Graziano
Robert C. Graziano, PhD, and Gillian LaRue, PsyD, Durham VA Healthcare System, Durham, NC, USA.
Gillian LaRue
Robert C. Graziano, PhD, and Gillian LaRue, PsyD, Durham VA Healthcare System, Durham, NC, USA.
Alicia J. Cohen
Alicia J. Cohen, MD, MSc, VA Providence Healthcare System, Providence, RI, USA; Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
Dina Hooshyar
Dina Hooshyar, MD, MPH, Veterans Health Administration, National Center on Homelessness among Veterans, Tampa, FL, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
H. Ryan Wagner
H. Ryan Wagner, PhD, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Jack Tsai
Jack Tsai, PhD, Veterans Health Administration, National Center on Homelessness among Veterans, Tampa, FL, USA; School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.