- By:
- Peluso, Alina ; Ramirez Osorio, Jorge M; Kazanis, William; Robinson, Amy; Martins, Susana; Cook, Hope B; Callaway, Kelley G; Schaefferkoetter, Noah T; Mc carthy, John; Oliva, Elizabeth; Kapadia, Anuj J; A trafton, Jodie
- Journal Name:
- BMJ Mental Health
- Page Number:
- 1-10
- Volume:
- 29
- Issue Number:
- 1
- Publication Date:
- June 24, 2026
- View DOI Listing:
- https://doi.org/10.1136/bmjment-2025-302338
Abstract
Background: Suicide is a major public health concern, particularly among Veterans. The U.S. Department of Veterans Affairs Veterans Health Administration (VHA) employs the Recovery Engagement and Coordination for Health–Veterans Enhanced Treatment (REACH VET) model to prioritise high-risk patients for targeted clinical attention. Objective: REACH VET 1.0 (RV 1.0) was developed on 2008–2011 data. To reflect changes in clinical practice and populations, VHA updated it to REACH VET 2.0 (RV 2.0). This study describes its development and validation. Methods: RV 2.0 used longitudinal data from 7,248,170 VHA patients (4,967 suicide deaths) in 2018–2019, with 650 time-varying demographic, clinical and area-level predictors derived from a 2-year lookback (2016–2019). An ensemble of Elastic-Net logistic regression models was trained on 2018 data and evaluated monthly at the population level in 2019, focusing on the top 0.1% intervention risk tier. Analyses assessed model discrimination, suicide detection, risk concentration, subgroup consistency (sex, age and race/ethnicity) and performance relative to RV 1.0 using the same percentile-based risk strata. Results: RV 2.0 outperformed RV 1.0 across all risk strata, with better discrimination (C-statistic 0.76 vs 0.69) and consistent performance across demographic subgroups. Within the top 0.1% of predicted risk, RV 2.0 identified more deaths, higher suicide rates and greater mortality risk concentration both when averaged across the 12 monthly 2019 test sets (5.6 vs 3.6; 83.6 vs 53.7 per 100,000 person-years; 21.0 vs 14.1) and when annualised for 2019 (67 vs 43; 2.7% vs 1.7%; 1,003 vs 644 per 100,000 person-years; 26.7 vs 17.1). Conclusions: RV 2.0 improves suicide risk stratification among Veterans, demonstrating better performance and consistent prediction across subgroups and highlighting the need for regular model updates and evaluation. Clinical implications: RV 2.0 enables targeted interventions and, since its national VHA implementation in June 2025, continues to support system-wide suicide prevention.
