The Role of Social Determinants of Health in Veteran Suicide: A Systematic Review

Abstract

Objective: Historically, veteran suicide research has primarily focused on individual-level risk factors, such as mental health; however, there have recently been calls to take a broader, public health approach. Emerging research suggests the importance of considering the contexts in which veterans live through the study of social determinants of health (SDoH). The objective of this systematic review was to address this need by examining the available literature regarding the link between SDoH and suicidality among veterans.

Methods: A keyword search of three online databases was conducted. Articles published between January 2001-May 2021 that examined at least one SDoH (e.g., financial insecurity, trauma) as a risk factor or correlate for suicidality among U.S. veterans were eligible for full-text review; data extraction and quality review was completed by two independent reviewers.

Results: Following the keyword search, 1,515 articles underwent title/abstract screening. Ninety-four (6.2%) were eligible for full-text review and extraction. Results revealed approximately half of the articles (n=46, 48.9%) assessed one SDoH, about a quarter (n=22, 23.4%) assessed two, and the remaining (n=26, 27.6%) assessed three to five. Trauma was the most assessed SDoH among the articles included in the review (n=54, 57.7%). The studies were primarily cross-sectional (n=59; 74.4%).

Conclusion: Although many articles examined SDoH, few included more than one factor, indicating a need for more comprehensive approaches to the study of suicidality in veterans. The results of this study can inform future research, and can be applied in the development of veteran risk screenings and suicide prevention efforts.