Post-military homelessness and criminal-legal involvement in relation to suicidal ideation and attempt among U.S. Veterans: results from a nationally representative survey

Abstract Background Veterans with histories of homelessness and criminal-legal involvement are at substantially elevated risk for suicide relative to those without such histories. However, prior research has been limited by focusing on lifetime history of these psychosocial stressors; thereby precluding increased understanding of the extent to which these experiences are associated with suicidal thoughts and behaviors during the post-military phase. Analyzing data from 17,396 Veterans who participated in Wave 1 of the Assessing Social and Community Environments with National Data (ASCEND) project, we evaluated associations of post-military homelessness and/or criminal-legal involvement to post-military suicidal ideation and attempt. Findings After adjusting for covariates, Veterans with histories of post-military homelessness and post-military criminal-legal involvement were more likely to report post-military suicidal ideation (61.61%; 95% confidence interval [CI]: 55.39, 67.47) and suicide attempt (26.57%; 95% CI: 21.11, 32.86), relative to Veterans without histories of either homelessness or criminal-legal involvement (suicidal ideation: 21.78%; 95% CI: 20.79, 22.81; suicide attempt: 2.99%; 95% CI: 2.61, 3.42). Conclusions Efforts to identify and engage Veterans experiencing post-military homelessness and criminal-legal involvement, including initiatives led by the Department of Veterans Affairs (VA), in suicide prevention services remain critical. Further evaluation of how to enhance, augment, and tailor such efforts, both within VA and the community, remains important.