Abstract
BACKGROUND: Veterans involved in the criminal legal system (CLS) exhibit disproportionately high rates of comorbid mental health and substance use disorders (COD) and homelessness-conditions that increase both the risk of recidivism and suicide. Despite elevated risk, limited research has examined the relationship between criminogenic risk factors and suicidality in this population. OBJECTIVES: This study examined differences in criminogenic risk, psychiatric burden, and social determinants of health (SDOH) among CLS-involved veterans with COD, comparing those with suicidality risk to those without. METHODS: Baseline data were analyzed from 127 veterans admitted to three Department of Veterans Affairs (VA) Mental Health Residential Rehabilitation Treatment Programs who were enrolled in a randomized controlled trial of the MISSION-CJ intervention (ClinicalTrials.gov Identifier: NCT04523337). Eligible veterans had recent CLS involvement and documented COD diagnoses. Assessments included the Level of Service Inventory-Revised (LSI-R), the Measures of Criminal Attitudes and Associates (MCAA), structured psychiatric interviews, standardized symptom inventories, and measures of social determinants of health. Suicidality risk was defined as experiencing recent thoughts of suicide and/or attempted suicide in their lifetime. RESULTS: Most veterans (80%) were classified as having moderate-high to high criminogenic risk based on total LSI-R scores. Compared to those without suicidality risk, veterans with suicidality risk demonstrated significantly higher criminogenic risk as evidenced by total LSI-R scores (p = .01), more antisocial attitudes (p = .04), particularly entitlement and violence beliefs (p = .02, p = .01, respectively), greater emotional and functional impairment (p < .001), and a higher prevalence of probable posttraumatic stress disorder (PTSD; 64% vs. 41%, p = .009). SDOH, including unstable housing and limited community integration, were highly prevalent but did not significantly differ between those with and without risk of suicide. CONCLUSIONS: Among CLS-involved homeless veterans with COD, suicidality was associated with elevated criminogenic risk and greater psychiatric burden, particularly PTSD. These findings underscore the need for integrated interventions that address both criminogenic and behavioral health factors to support recovery, reduce suicide risk and mental health symptoms, and mitigate CLS recidivism. TRIAL REGISTRATION: This study was preregistered at https://ClinicalTrials.gov with registration number NCT04523337.