United States military veteran suicide

United States military veteran suicide refers to the high rate of suicides among veterans in comparison with the general public. According to the US Department of Veterans Affairs, on average, 17 US veterans died by suicide each day in 2019—about 6,200 that year—with some suicides occurring in Veterans Affairs (VA) hospitals or on their grounds. While the early 2020s saw a slight decrease in the suicide rate among veterans, suicide prevention remained a top priority of the VA. The most common stressors for veterans transitioning from military to civilian life are relationship problems, feelings of isolation and separation, legal troubles, and difficulties in the workplace. Medical issues such as PTSD (post-traumatic stress disorder) and TBIs (traumatic brain injuries) also increase the risk of suicide. According to Veterans Affairs, the risk of suicide for military veterans is highest during the first year after leaving the military, and more than 1.7 million veterans received mental health services from the department between February 2020 and February 2021.

Background

According to the World Health Organization (WHO), nearly one million people die by suicide each year. Of those, a relatively small number are veterans or active-duty military personnel. This is largely because only a small percentage of the US population serves or has served in the military. In the past, military suicide rates were lower than those for the general population. However, from the second half of the twentieth century into the twenty-first century, this trend changed. By 2022 suicide had become one of the leading causes of death in the military.

Starting in 2001, after the September 11 terrorist attacks, the US government began closely monitoring the number of deaths by suicide among military veterans and active-duty personnel. In 2012 the US Department of Veterans Affairs (VA) released its Suicide Data Report, which analyzed death certificates from twenty-one states from 1999–2012 and calculated the percentage of suicides identified with veterans. From this, it determined that about twenty-two veterans died by suicide each day during that period, which is about eight thousand per year. However, later and more accurate studies determined that this number was closer to twenty veterans dying by suicide per day, or six thousand per year.

In 2016, Veterans Affairs released the results of a study indicating that the suicide rate among US veterans had increased by 32 percent from 2001 to 2014. (Civilian suicides increased by 23 percent during the same period.) The study also found that suicides were more common among those who did not use Veterans Health Administration (VHA) services. Suicide rates for male veterans who used VHA services increased by 11 percent since 2001, while suicide rates for those who did not use these services increased by 35 percent. The contrast was starker for women. Suicide rates for female veterans who used VHA services increased by 4.6 percent, while suicide rates for those who did not use these services increased by 98 percent. According to the report, the risk of suicide among female veterans was 2.4 times higher than among civilian women in 2014.

Another report released by Veterans Affairs on September 26, 2018, tracked the suicide rate of veterans from 2005 to 2016, a time when there was a spike in the number of suicides committed by younger veterans, ages 18 to 34. About 45 deaths per 100,000 veterans occurred in this age group, which consisted of mostly veterans who had served in either the war in Iraq or the war in Afghanistan. (The civilian suicide rate was 14 deaths per 100,000.) However, at that time, the majority of veteran suicides occurred among veterans older than fifty-five, indicating that the negative psychological effects of military service can be long-lasting.

According to Brown University's Costs of War Project, by June 2021 30,177 active duty personnel and veterans of post-9/11 conflicts had died by suicide, a figure far larger than the 7,057 service members killed in action during that time. That year, the new Veterans Affairs data report indicated that between 2001 and 2019, the suicide rate among veterans rose by 35.9 percent, and veterans had a 52.3 percent higher suicide rate than US civilians in 2019.

With the declaration of the coronavirus disease 2019 (COVID-19) pandemic in March 2020, Veterans Affairs and activist organizations became even more concerned about veterans' mental health due to the stressful ways in which the pandemic altered everyday life. While the 2021 Veterans Affairs report found that, as of September of that year, there had not been an increase in veteran suicide behaviors, it also stressed that data and surveillance tools remained limited at that point and vigilance, as well as prevention, efforts remained crucial among continued virus control policies such as business closures, isolation, and physical distancing.

Risk Factors

Transitioning from military to civilian life is difficult for many veterans. Integrating back into families and communities can be overwhelming. Relationship problems, legal troubles, and workplace difficulties all increase a veteran’s risk of suicide.

Medical problems that put veterans at a higher risk of suicide include TBI (traumatic brain injuries), chronic pain, and sleep disorders. Other risk factors for veterans include homelessness and easy access to firearms.

Experts have found a strong link between PTSD (post-traumatic stress disorder) and a high risk of suicide. A study conducted by Veterans Affairs found that veterans are more likely to develop PTSD if they have served a long time during a war or under severe combat conditions, if they have witnessed the death of soldiers around them, if they have been shot at or received mortar fire, and if they have suffered brain or head trauma or life-long physical injuries. Other risk factors include being female and having a low level of education.

Some risk factors are not unique to veterans but apply to all individuals. These include a shortage of mental health facilities, particularly in rural areas, an inadequate health-care system, and a lack of funding for suicide research.

Prevention

Veterans Affairs shoulders most of the blame for veterans not getting the care and treatment they need to prevent them from taking their own lives. A disturbing trend has been the increasing number of veterans in Veterans Affairs hospitals dying by suicide. From 2017 to early 2019, twenty-five veterans died by suicide on the grounds of VA hospitals. Experts claim that these veterans made a powerful statement about their inadequate care. Among the twenty-five veterans was a thirty-three-year old marine who died by suicide in 2018. An investigation after his death revealed several mistakes made by the hospital including overlooking his access to firearms and failing to schedule a follow-up appointment with a doctor. The marine’s antidepressants arrived in the mail two days after his death.

Veterans Affairs has implemented some positive changes, including beginning to track suicides at its facilities in 2017. The department has expanded its suicide crisis hotline, created programs offering veterans same-day care for mental health emergencies, and contacted veterans who recently left the military but are not using the veterans’ health care system.

Veterans Affairs cannot prevent suicides on its own, however. In a 2020 Veterans Affairs report, it was estimated that in 2017 about 51 percent of veterans did not utilize Veterans Affairs services, which can be an essential part of suicide prevention. Because of this, experts see a need for suicide prevention training in the field of general medicine. If this should occur, physicians might be better able to identify signs of PTSD, for example.

Among the legislation passed to prevent veteran suicides is the 2015 Clay Hunt Suicide Prevention for American Veterans Act, named after Clay Hunt, a twenty-eight-year-old marine and veterans advocate who died by suicide in 2011. Among the act’s goals is to increase veterans’ access to mental health care with the creation of a community outreach program.

In March 2019, President Donald Trump signed the National Initiative to Empower Veterans and End Veteran Suicide. The executive order mandated the creation of the Veteran Wellness, Empowerment, and Suicide Task Force to develop a roadmap to lower the rate of veteran suicides. The administration of Joe Biden, who became president in 2021 following the 2020 general election, announced a new comprehensive, cross-sector, evidence-informed federal strategy aimed toward the reduction of military and veteran suicide. The main pieces of the strategy involved improving high-quality crisis care access, ensuring a person in crisis does not have immediate access to lethal means, improving the accessibility of mental health care, addressing factors that contribute to an increased suicide risk, and increasing the sharing and intervention of suicide risk and outcomes data between prevention agencies.

In August 2022 Biden signed a package of veterans' healthcare policies into law; among other reforms, this legislation expanded access to disability payments for millions of veterans exposed to toxic substances and environmental hazards during their military service. Other priorities during Biden's tenure included expanding mental healthcare access for veterans living in rural areas and broadening VA healthcare access for veterans who did not receive honorable discharges from the military.

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