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Journal Article


The Lancet. Lancet 2019; 394(10201): 806.


(Copyright © 2019, Elsevier Publishing)






An update to the US Department of Veterans Affairs and Department of Defense guidelines for the assessment and management of patients at risk of suicide was published in the Annals of Internal Medicine on Aug 27, 2019, the first update since the creation of the original guidelines in 2013. These expanded guidelines come as the incidence of suicide in the USA grows ever greater.
Suicide rates have increased by 25% in the US population between 1999 and 2016, but the same period has seen suicide rates among US veterans more than double, from 10·7 per 100 000 to 21·5 per 100 000. According to the American Foundation for Suicide Prevention, suicide and self-injury cost the USA $69 billion in 2015. Veterans have a 21% higher suicide rate than age-matched and sex-matched civilian cohorts.

One major change is the requirement that the Department of Veterans Affairs screen all its patients for suicide risk, whereas the previous guidelines suggested intervention only in patients presenting with suicidal or self-directed violent behaviours. The new guidelines suggest the raised number of suicides in the veteran population justifies universal screening. Other new recommendations include cognitive behavioural-based interventions.

An interesting addition is the specification that veterans deemed at risk of suicide and self-harm should have their access to “lethal means” restricted. 66% of suicides by male veterans involve a firearm, and nearly half of all veterans own a firearm. Of the 38 658 firearm deaths in the USA in 2017, 23 854 were suicides. It is heartening to see a government body acknowledge that firearms remain a public health risk...

Language: en


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