Suicide death following a crisis line contact: The importance of treatment initiation and continuation.

Abstract

The purpose of this study was to determine whether initiating or connecting with behavioral health care (BHC; mental health and substance use) following a Veterans Crisis Line (VCL) contact was associated with reduced likelihood of suicide. A retrospective cohort design was used to examine the association of BHC in the month (0-30 days) following a crisis line contact (i.e., calls, texts, and chats) with suicide death over a year (days 31-365) among 317,515 VCL contacts from 2015-2019. Contacts were divided into 1) non-BHC users, 2) BHC initiators, 3) BHC continuers, and 4) BHC discontinuers. Logistic regression was used with BHC discontinuers as reference. Secondary analyses were conducted with any health care (HC). Non-BHC users, adjusted odds ratio (AOR) (95% CI) = 0.29 (0.23-0.38), BHC initiators, AOR (95%CI) = 0.46 (0.35-0.61), and BHC continuers, AOR = 0.63 (0.47-0.83), were less likely to die by suicide than those who discontinued BHC. Non-HC users, AOR (95% CI) = 0.22 (0.16-0.29), HC initiators, AOR (95%CI) = 0.34 (0.25-0.45), and HC continuers, AOR = 0.48 (0.36-0.64), were also less likely to die by suicide than HC discontinuers. Initiating and continuing with BHC following a crisis line contact was associated with a lower likelihood of suicide than discontinuing with BHC. Veterans who never used BHC may include one or more subpopulations at low suicide risk. Those who discontinue BHC may be at high suicide risk, suggesting a need for additional research and possible intervention. Similar associations were found for any HC.