Abstract
Background and Objectives
Veterans face disproportionate suicide and mortality risks driven by intersecting social determinants of health (SDH), including housing instability, unemployment, and justice involvement, and co-occurring substance use disorders (SUD). This study examined how these intersecting factors influence mortality and whether SUD treatment mitigated mortality risks among US veterans.
Methods
Using national Veterans Health Administration data (2014–2019), we identified 215,944 veterans with SUD and an indicator of one of three adverse SDH: housing instability, justice involvement, or unemployment. We tracked suicide and all-cause mortality for 1 year following SDH exposure. We used discrete-time survival models to assess associations between month-specific SUD treatment and mortality outcomes, controlling for demographic, clinical (i.e., mental health conditions, suicidal behavior), and contextual covariates.
Results
Nearly half of veterans (48%) received SUD treatment. Those who received treatment had lower all-cause mortality (2.1% vs. 4.3%; p < .001) but no significant difference in suicide mortality (0.1% vs. 0.6%; p = .75). SUD treatment was associated with a 24% (aOR = 1.24; 95% CI: 1.16–1.34) reduction in all-cause mortality, though its interaction with each adverse SDH was not statistically significant. Suicide deaths remained concentrated among White veterans, those aged 18-34, with no service connection, and with time-varying suicidal ideation or attempts (p < .001).
Discussion and Conclusions
Engagement in SUD treatment reduces all-cause mortality among veterans facing compounded social adversity but does not independently mitigate suicide deaths.
Scientific Significance
Integrated approaches that embed suicide prevention within addiction and SDH-focused care are essential to address the multifactorial drivers of veterans’ suicidal mortality.