Linking data to understand veteran suicide and direct effective prevention programs
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Linking Data to Understand Veteran Suicide and Direct Effective Prevention Programs. Claire Hoffmire, PhD Department of Veterans Affairs VISN2 Center of Excellence for Suicide Prevention. Suicide Mortality Surveillance: The Cornerstone of Suicide Prevention. Effective surveillance systems:

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Linking Data to Understand Veteran Suicide and Direct Effective Prevention Programs

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Linking Data to Understand Veteran Suicide and Direct Effective Prevention Programs

Claire Hoffmire, PhD

Department of Veterans Affairs

VISN2 Center of Excellence for Suicide Prevention

Suicide Mortality Surveillance: The Cornerstone of Suicide Prevention

  • Effective surveillance systems:

    • Inform the development of targeted prevention strategies that have the potential to meaningfully reduce suicide burden

    • Help to evaluate the impact of existing and newly implemented prevention programs.

  • National suicide surveillance systems:

    • National Violent Death Reporting System (NVDRS)

    • NDI

    • VA State Mortality Project

  • National priority to improve suicide surveillance

    • 2012 National Strategy for Suicide Prevention goal

      • “Increase the timeliness and usefulness of national surveillance systems relevant to suicide prevention and improve the ability to collect, analyze, and use this information for action.”

National Average:


Data obtained from WISQARS Fatal Injury Reports:

NVDRS Coverage

Suicide among U.S. VeteransPercentage of all Suicides Identified as Veterans

Estimated Number of Veterans Who Die From Suicide Each Day

The State Mortality Data Project

  • “The Department of Veterans Affairs believes that a comprehensive suicide prevention program requires timely and accurate information beyond that acquired from it’s internal patient population.” – 2012 Suicide Data Report

    • Overcome delay’s associated with national mortality data

    • Accurately identify true Veterans

    • Understand suicide among all Veterans

    • Evaluate differences and changes in outcomes among VHA utilizing Veterans

  • A State-VA Collaborative Project

    • In 2010 VA Secretary Shinseki requested collaboration and support from all U.S states

    • Data on all known suicides reported from 1999 through 2015

    • Will be used, in part, to fulfill Public Law 111.163 to determine the number of Veterans who died from suicide 1999-2009

Project Status: May 2013

  • Data Requested from death certificates

    • SSN, Name, DOB, DOD, Age, Sex, Race/ethnicity, Marital status, Education, ICD-10 Cause of death, State & County of residence, County of death, Veteran Status, Industry, occupation

  • Project Barriers

    • Inconsistent availability of requested information in all states

    • State barriers to providing non-resident data

    • State preference to provide de-indentified data due to conflicting interpretation of Social security laws

Project Status






In Negotiation

Linking to VA Data

  • Validation of Veteran Status

    • Partnership with the DOD to accurately identify all Veterans

    • Preliminary evidence indicates that death certificate misclassification exists

    • Improve comparison of Veterans to non-Veterans

  • Identification of VHA service utilization

    • Directly compare VHA & non-VHA Veterans for the first time

    • Medical information also available for VHA users

  • Inclusion of state data in suicide mortality repositories

    • VA Suicide Data Repository

      • State records, annual VA NDI all-cause search, SPAN, VCL, expanded VA-DoD NDI search

    • VA-DoD collaborative Data Repository

      • VA-DoD NDI search, limited DoD service record, DoDSER

Comparing SDR to National Suicide Surveillance Efforts

State Mortality Project Preliminary Findings: Death Certificate misclassification of Veteran status

1999-2008 overall Sensitivity Estimates

Males: 90%

Females: 68%

18-39 years: 84%

40-64 years: 92%

The Veteran population is changing

Joining Forces to Save Lives:Why initiate or continue State-VA Partnerships?

  • The Veteran population is changing making accurate and timely surveillance of Veteran suicide mortality more critical than ever

  • Veterans make up nearly 20% of all suicide decedents

    • Nearly 8,000 Veterans die by suicide every year

    • In the next 5 years, the NAASP set a goal to save 20,000 lives = 4,000 lives annually

  • Partnering with the VA can greatly improve the accuracy of Veteran status reporting on death certificates

  • Coverage far exceeds that of NVDRS and can inform its expansion

  • VA and DoD can add critical information to inform prevention

  • VA Secretary Shinseki has requested the help of State Health Departments to improve our understanding of Veteran suicide and save lives

The Ultimate Goal: Identify all Veteran Suicides

State suicide death certificates

We’re working together to close this gap!

VA-DOD NDI search

VHA Veterans

All Veteran Suicides


  • Jan Kemp, RN, PhD – VA National Mental Health Program Director

  • Robert Bossarte, PhD – Acting Associate Director, COE

  • Kenneth Conner, PsyD, MPH – Director, COE

  • Rebecca Piegari, MS – Statistician, COE

  • Brady Stephens, MS – Statistician, COE

  • Heather Shaw, BS – Research Assistant, COE

  • Janet McCarten, PhD – Health Science Specialist, COE

  • Participating State Health Department POCs

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