Two studies examine the phenomenon of Veterans and service members taking their lives shortly after contact with mental health providers. One study finds a high risk of suicide for Veterans in the week following discharge from a psychiatric unit. The other study says many soldiers who die by suicide access health care shortly before death, presenting an opportunity for suicide prevention. In the latter study, mental health encounters were much more prevalent for suicide decedents, or those who took their lives, compared with soldiers who had also visited mental health units but didn't die by suicide.

Dr. Natalie Riblet, a psychiatrist at the White River Junction VA Medical Center in Vermont, led the study relating to Veteran suicides. She spoke about why a recent psychiatric hospitalization may be a risk factor for suicide.

"That is a great question and something that researchers are still trying to completely understand," she says. "Part of the reason is because the hospitalization is simply a marker of the severity of the patient's underlying mental illness. We know that mental illness such as major depression is a strong risk factor for suicide."

Dr. Peter Gutierrez, a clinical research psychologist at the VA Eastern Colorado Health Care System, co–authored the other study, which relies on data from Army STARRS, the Army Study to Assess Risk and Resilience in Service Members. The study, published in April 2017 in the Journal of Consulting and Clinical Psychology, looks at 569 Army soldiers who died by suicide from 2004 to 2009. It says about 50 percent of the soldiers accessed health care in the month before their death and about 25 percent in the week prior. Most of those visits were in a mental health unit.

"This suggests that opportunities exist to intervene with a substantial proportion of suicide decedents in the months before death by focusing on patients in mental health treatment," the researchers for Gutierrez's study write. How can professionals intervene in that scenario?

Gutierrez explains that health providers carry a burden to be aware of which of their patients are at risk based on factors that typically don't change much: age, gender, and prior history of suicide–related behaviors. When providers sense an elevated risk of suicide, he says, they should routinely ask their patients about thoughts of suicide, preparation for a suicide attempt, and level of intent to engage in self–harm.

"It's one of those things where if you ask patients the right way, most of them are likely to tell you," he says. "But if you don't ask they're just not going to volunteer the information. And since it's not like heart disease, where there are clear biomarkers of risk, this isn't the sort of thing, unlike a blood test or vital signs or anything like that, where you can assume the likelihood of a negative outcome is imminent."

For their study, Riblet and her team reviewed VA clinical reports of death by suicide within seven days of discharge from all VA inpatient mental health units from 2002 to 2015. The reports looked, in part, at the root causes of the suicide. The study, published in The Journal of Nervous and Mental Disease, cites 141 reports of suicide during that period, 43 percent of which (61) followed an unplanned discharge. That means the discharge occurred against medical advice or the patient unexpectedly requested to move up the discharge after it was scheduled for a later time.

The study says inpatient teams should be aware of the "potentially heightened risk" for suicide in patients taking an unplanned discharge.