@article{ref1,
title="County characteristics and veteran suicide in the United States, 2011-2018",
journal="American journal of preventive medicine",
year="2024",
author="Denneson, Lauren M. and Bollinger, Mary J. and Phillips, Rachel and Chen, Jason I. and Carlson, Kathleen F.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="INTRODUCTION: Few studies have examined county-level hotspots of veteran suicide and associated place-based contributors, limiting development of targeted community-level prevention strategies. The objectives of this national spatial analysis of all veteran suicides were to identify areas of the United States (U.S.) with higher-than-expected veteran suicide rates and determine county-level social and economic characteristics associated with areas of higher risk. <br><br>METHODS: Using Bayesian hierarchical modeling, county-level standardized mortality ratios for veteran suicide deaths were estimated for time periods 2011-2018, 2011-2014, and 2015-2018. Adjusted relative risk, accounting for community characteristics, for each county was then estimated and associations between community characteristics and veteran suicide risk were examined. Analyses were conducted in 2023-2024. <br><br>RESULTS: Risk of veteran suicide is predominantly concentrated in the Mountain West and West. Significant predictors of risk across all time periods were per capita number of firearm retailers (2011-2018 RR=1.065 [95%CI 1.030-1.102]), the proportion of residents who moved in the past year (2011-2018 RR=1.060 [95%CI 1.039-1.081]), the proportion of residents who live alone (2011-2018 RR=1.067 [95%CI 1.046-1.089]), the proportion of residents in rental housing (2011-2018 RR=1.041 [95%CI 1.018-1.065]), and the proportion of married residents (2011-2018 RR=0.915 [95%CI 0.890-0.941]). <br><br>CONCLUSIONS: This study contributes to a comprehensive public health approach to veteran suicide prevention by identifying where resources are needed most, and which place-based intervention targets have the largest potential for impact. <br><br>FINDINGS suggest that public health efforts to address suicide among veterans should address community level firearm access and identify ways to alleviate deleterious effects of social fragmentation.<p /> <p>Language: en</p>",
language="en",
issn="0749-3797",
doi="10.1016/j.amepre.2024.06.011",
url="http://dx.doi.org/10.1016/j.amepre.2024.06.011"
}