Food Insecurity and Suicidal Ideation: Results from a National Longitudinal Study of Military Veterans

Abstract

Objective

Research examining social determinants of suicide risk in veterans suggests a potential link between food insecurity and subsequent suicidal ideation in military veterans. The objective of this study is to investigate, if and how, food insecurity predicts subsequent suicidal ideation in a nationally representative longitudinal survey of veterans.

Methods

A national longitudinal survey was analyzed of participants randomly drawn from over one million U.S. military service members who served after September 11, 2001. N = 1,090 veterans provided two waves of data one year apart (79% retention rate); the final sample was representative of post-9/11 veterans in all 50 states and all military branches.

Results

Veterans with food insecurity had nearly four times higher suicidal ideation one year later compared to veterans not reporting food insecurity (39% vs 10%). In multivariable analyses controlling for demographic, military, and clinical covariates, food insecurity (OR = 2.37, p =.0165) predicted suicidal ideation one year later, as did mental health disorders (OR = 2.12, p = .0097). Veterans with both food insecurity and mental health disorders had a more than nine-fold increase in predicted probability of suicidal ideation in the subsequent year compared to veterans with neither food insecurity nor mental health disorders (48.5% vs. 5.5%).

Conclusion

These findings identify food insecurity as an independent risk marker for suicidal ideation in military veterans in addition to mental disorders. Food insecurity is both an indicator of and an intervention point for subsequent suicide risk. Regularly assessing for food insecurity, and intervening accordingly, can provide upstream opportunities to reduce odds of suicide among veterans.

HIGHLIGHTS

• Military veterans with food insecurity were at elevated risk of suicidal ideation.

• Veterans with mental health disorders had higher odds of suicidal ideation one year later.

• Food insecurity plus mental health disorders led to a substantial increase in suicidal ideation.

Keywords:

• Food insecurity
• military
• suicidal ideation
• veterans

ACKNOWLEDGMENTS

We would like to extend our sincere thanks to those who volunteered for this study. The second and third authors, both funded through the Department of Veterans Affairs Psychosocial Rehabilitation and Recovery Fellowship, made equal contributions to this manuscript and are listed in alphabetical order. The views expressed in this article are those of the authors and do not necessarily represent the views of the National Institutes of Health or the Department of Veteran Affairs.

Additional information

Funding

This work was supported by the National Institute of Mental Health under grant award R01MH080988, the Office of Research and Development Clinical Science of the Department of Veterans Affairs, and the Mid-Atlantic Mental Illness Research, Education and Clinical Center. Dr. Alicia J. Cohen was supported by Department of Veterans Affairs HSR&D grant CDA 20-037.

Notes on contributors

Eric B. Elbogen

Eric B. Elbogen, PhD, Veterans Health Administration, National Center on Homelessness among Veterans, Tampa, FL, USA; Durham VA Healthcare System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.

Robert C. Graziano

Robert C. Graziano, PhD, and Gillian LaRue, PsyD, Durham VA Healthcare System, Durham, NC, USA.

Gillian LaRue

Robert C. Graziano, PhD, and Gillian LaRue, PsyD, Durham VA Healthcare System, Durham, NC, USA.

Alicia J. Cohen

Alicia J. Cohen, MD, MSc, VA Providence Healthcare System, Providence, RI, USA; Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.

Dina Hooshyar

Dina Hooshyar, MD, MPH, Veterans Health Administration, National Center on Homelessness among Veterans, Tampa, FL, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.

H. Ryan Wagner

H. Ryan Wagner, PhD, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.

Jack Tsai

Jack Tsai, PhD, Veterans Health Administration, National Center on Homelessness among Veterans, Tampa, FL, USA; School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.