Peer Reviewed Articles on Suicide in the Military 2017
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Suicide is a major public health challenge that unduly affects service members and veterans. Researchers accept been studying veteran suicide rates and prevention strategies, but there are opportunities to improve risk identification, evaluation, support, and treatments and interventions. These strategies must include community-based efforts to reach veterans exterior the U.Due south. Department of Veterans Affairs system.
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Suicide is a major public health issue and amongst the top ten causes of death in the The states. Unfortunately, for more than a decade, the suicide rate has been rising in the general U.Due south. population and especially among veterans, men and women who risked their lives for the state. This Veterans' Problems in Focus Perspective presents data on the magnitude of the problem, identifies particularly noteworthy issues and trends, highlights recent advances, and identifies gaps that deserve increased attention from both researchers and policymakers. In its 2018–2024 strategic plan, the U.S. Department of Veterans Affairs (VA) identified preventing veteran suicide as its highest clinical priority, and the RAND Epstein Family Veterans Policy Research Constitute is committed to helping VA—and the country—achieve this critical goal.
Magnitude of the Problem
In 2018, 6,435 veterans and 40,075 nonveteran adults died by suicide. Simply because in that location are many more nonveterans in the population, the rate of suicide among veterans was 32.0 per 100,000, compared with 17.2 per 100,000 for nonveterans (VA, 2020b).
Trends over Fourth dimension
For the by 12 years, suicide rates have been consistently higher among veterans than nonveterans. Furthermore, since 2005, the suicide charge per unit has risen faster among veterans than it has for nonveteran adults. Effigy 1 shows age- and sexual practice-adjusted rates over time (which are better for comparing between groups); every bit of 2019, adapted rates of suicide were 27.5 per 100,000 for veterans and eighteen.2 per 100,000 for nonveterans (VA, 2020b).
Figure 1. Age- and Sexual practice-Adjusted Suicide Rates Among Veterans and Nonveterans, 2005–2018
| Veterans | Nonveterans | |
|---|---|---|
| 2005 | 18.5 | 15.5 |
| 2006 | 17.viii | 14.6 |
| 2007 | xix.1 | 15.0 |
| 2008 | 20.9 | 15.2 |
| 2009 | 21.4 | 15.four |
| 2010 | 21.8 | 15.ix |
| 2011 | 22.half-dozen | 16.2 |
| 2012 | 22.8 | 16.5 |
| 2013 | 24.0 | 16.5 |
| 2014 | 25.2 | 16.eight |
| 2015 | 26.3 | 17.1 |
| 2016 | 25.eight | 17.3 |
| 2017 | 27.3 | 17.9 |
| 2018 | 27.five | 18.2 |
SOURCE: Data from VA, 2020b, data appendix.
Pressing Bug
The greatest departure in suicide rates betwixt veterans and nonveterans is amidst those ages 18–34.
In 2018, the suicide rate among veterans 18–34 years old was 45.9 per 100,000—higher than in whatsoever other age grouping in either population and almost three times higher than for nonveterans in the aforementioned age subclass (16.5 per 100,000). This equated to 874 suicide deaths among veterans ages 18–34 (796 men and 78 women) in 2018.
The largest number of veterans who die by suicide are between 55 and 74 years old.
In 2018, 2,587 veterans ages 55–74 died by suicide, a charge per unit of 30.4 per 100,000 (compared with 17.0 per 100,000 amongst nonveterans in the same age bracket).
The difference in suicide rates between veterans and nonveterans is greater among women than men, but for both veterans and nonveterans, rates are higher amongst men.
In 2018, the suicide charge per unit for veteran women was 14.8 per 100,000 (291 deaths), almost twice the rate for nonveteran women (7.6 per 100,000). The difference was greatest among women ages 18–34 (veterans: 21.8; nonveterans: 6.8 per 100,000). That same year, the suicide charge per unit amongst veteran men was 1.2 times the charge per unit among nonveteran men (33.viii versus 29.0 per 100,000). For men, the divergence was also greatest amid xviii- to 34-year-olds (veterans: 51.5; nonveterans: 26.4 per 100,000).
Veterans who dice by suicide are more than likely to use a firearm than civilians who die by suicide.
In 2018, 68.2 per centum of veterans who died by suicide used a firearm, compared with 48.2 percent of nonveterans. Figure 2 shows these proportions overall and for men and women.
Figure 2. Percentage of Veterans and Nonveterans Who Died by Suicide, Firearm Utilize, 2018
| Veterans | Nonveterans | |
|---|---|---|
| Overall | 68.2% | 48.2% |
| Men | 69.4% | 53.5% |
| Women | 41.ix% | 31.7% |
SOURCE: Information from VA, 2020b, data appendix.
Veterans with mental health diagnoses accept a significantly elevated suicide take chances.
Past many measures, the mental health care provided past VA through the Veterans Health Administration (VHA) is college-quality than the care available through private providers, and, in some areas, information technology might be improving (O'Hanlon et al., 2017; VA, 2020b). However, the rate of suicide amidst VHA patients with a mental health or substance use disorder diagnosis was 57.2 per 100,000—more than double the charge per unit amongst those without these diagnoses.
Specifically, suicide rates were highest among VHA patients diagnosed with opioid utilise disorder or bipolar disorder (both betwixt 120 and 130 suicide deaths per 100,000), followed by schizophrenia and substance use disorders overall (both between fourscore and 100 deaths per 100,000), anxiety (67 per 100,000), low (66.4 per 100,000), and posttraumatic stress disorder (between 50 and threescore per 100,000). There is also show that veterans with traumatic brain injuries are at increased hazard of suicide compared with those without these injuries (Hostetter et al., 2019).
There is mixed evidence about the role of gainsay exposure in suicide risk. In one study, among all service members who deployed from 2001 to 2007, deployment was non associated with increased suicide risk between 2001 and 2009 (Reger et al., 2015). However, amongst those who served in the agile-duty Army between 2004 and 2009, suicide take a chance was elevated during agile service for currently and previously deployed soldiers (Schoenbaum et al., 2014).
Data on Veteran Suicide
In 2012, VA and the U.Southward. Department of Defense (DoD) collaborated to create the VA/DoD Mortality Data Repository. Each year, VA and DoD generate a list of all veterans, nonveteran VA patients (such as the eligible dependents of veterans), and active-duty armed forces personnel, which is matched to the National Death Alphabetize maintained by the Centers for Disease Control and Prevention (CDC). This produces a data set with causes of decease for all veterans each yr, regardless of their eligibility or apply of VA benefits (Hoffmire et al., 2020).
Notable Advances in Enquiry and Practice
The rate of veteran suicide, reflecting thousands of lives lost each year, warrants greater attention from VA, other federal agencies, state and local governments, and organizations that serve veterans. There have been some notable advances in research and practice that might help reduce suicide amid veterans.
Emerging bear witness suggests that screening and risk assessments for suicide tin exist lifesaving.
Screening all patients for suicide risk in mental health, emergency, and primary care settings tin can notice those who might exist thinking about harming themselves, discern their current level of risk, and provide opportunities to offer appropriate intendance—ultimately reducing suicide attempts (Miller et al., 2017). Screening can be conducted efficiently using validated tools, such equally the Inquire Suicide-Screening Questions (ASQ) tool, across health care settings (Roaten et al., 2018; National Institute of Mental Health, undated; Thom, Hogan, and Hazen, 2020). As part of its National Strategy for Preventing Veteran Suicide, VA developed Take a chance ID, a three-stage suicide screening process that has been implemented successfully in VA settings (VA, 2018; Bahraini et al., 2020).
VA's ReachVet program can identify veterans at risk of suicide who would take otherwise been missed.
VA's ReachVet program applies statistical algorithms to clinical data to produce a monthly list of veterans with the highest probability of dying by suicide (Reger et al., 2019). A coordinator at each VA facility receives the list of at-take chances patients and alerts the veterans' health care providers.
VA is expanding its Caring Contacts program based on promising show that such contacts tin save lives.
Caring contacts are brief, personal, nondemanding follow-up messages sent to patients after they receive care. These messages have been linked to decreased suicide attempts (Motto and Bostrom, 2001). VA now sends follow-upwardly letters to veterans who receive care at a VA facility or telephone call the Veterans Crunch Line and cull to identify themselves to the phone call responder (VA, 2020a). VA researchers are testing the approach with other patient populations, including those seen in VA emergency departments (Landes et al., 2019).
Community-based initiatives could yield promising approaches to preventing veteran suicide.
Several efforts have recently been launched to promote community-based approaches to suicide prevention. The CDC's community prevention framework has seven components, ranging from providing economic support to promoting connectedness and creating a protective surroundings (Stone et al., 2017). In partnership with VA, the Substance Abuse and Mental Wellness Services Administration (SAMHSA) recently issued a claiming (and is providing assistance) to governors and mayors across the United States to create and implement suicide prevention plans targeting service members, veterans, and their families. As of Nov 2020, 27 states and 18 communities were participating in the program (SAMHSA, 2020). Prior customs-based initiatives similar in construction merely focused on youth suicide prevention have produced promising results (Garraza et al., 2015, 2018, 2019).
Directions for Hereafter Research
Researchers have been engaged in multiple research efforts to address veteran suicide, and many studies are ongoing. There remains much to explore to amend understand why veterans take their lives and how policies and practices could enable constructive interventions.
- Although VA has implemented various suicide prevention strategies, not all veterans are eligible or opt to receive care through VA. Among veterans who died by suicide in 2018, 63 percent (4,057 of 6,435) did non have an encounter with VHA in the year of their death or the year prior. Still, many may have been receiving care outside of VA; amid the general insured population, equally many every bit 83 percent of those who die by suicide had a health intendance visit in the year before their death (Ahmedani et al., 2014). There is a need for more enquiry on veterans' non-VA health intendance encounters and for studies to develop, test, inform, and evaluate community-based efforts to reach veterans exterior of VA.
- There are groups of veterans that are hard to reach and may be at increased run a risk of suicide, including those who are involved in the criminal justice system; those who are experiencing homelessness; those who identify equally lesbian, gay, bisexual, transgender, or queer (LGBTQ); those who accept received other-than-honorable discharges from the military machine; and veterans who are isolated or alone. Veterans could autumn into more than ane of these groups. There is a need for research to identify whether and to what extent specific veteran subpopulations are at heightened chance for suicide and whether unique supports are needed to address their risk.
- There are gaps in most U.S. communities' ability to effectively intervene with individuals in crisis. They ofttimes rely on legal interventions or unnecessary hospitalizations that either delay or increment suicide take a chance (Hogan and Goldman, 2021). In that location is a need for more research to evaluate the harms of current crunch responses, particularly amongst loftier-hazard veteran subpopulations; to identify novel solutions for responding to crises; and to evaluate the effectiveness of promising new approaches.
References
- Ahmedani, Brian 1000., Gregory E. Simon, Christine Stewart, Arne Beck, Beth E. Waitzfelder, Rebecca Rossom, Frances Lynch, Ashli Owen-Smith, Enid One thousand. Hunkeler, Ursula Whiteside, Belinda H. Operskalski, M. Justin Coffey, and Leif I. Solberg, "Health Care Contacts in the Year Before Suicide Death," Journal of General Internal Medicine, Vol. 29, No. 6, June 2014, pp. 870–877.
- Bahraini, Nazanin, Lisa A. Brenner, Catherine Barry, Trisha Hostetter, Janelle Keusch, Edward P. Post, Chad Kessler, Cliff Smith, and Bridget B. Matarazzo, "Assessment of Rates of Suicide Take chances Screening and Prevalence of Positive Screening Results Amid United states Veterans Later on Implementation of the Veterans Affairs Suicide Risk Identification Strategy," JAMA Network Open, Vol. 3, No. 10, Oct 21, 2020, commodity e2022531.
- Garraza, Lucas Godoy, Simone Peart Boyce, Christine Walrath, David B. Goldston, and Richard McKeon, "An Economic Evaluation of the Garrett Lee Smith Memorial Suicide Prevention Program," Suicide and Life-Threatening Behavior, Vol. 48, No. 1, Feb 2018, pp. 3–xi.
- Garraza, Lucas Godoy, Nora Kuiper, David B. Goldston, Richard McKeon, and Christine Walrath, "Long-Term Impact of the Garrett Lee Smith Youth Suicide Prevention Program on Youth Suicide Mortality, 2006–2015," Journal of Child Psychology and Psychiatry, Vol. sixty, No. 10, October 2019, pp. 1142–1147.
- Garraza, Lucas Godoy, Christine Walrath, David B. Goldston, Hailey Reid, and Richard McKeon, "Consequence of the Garrett Lee Smith Memorial Suicide Prevention Plan on Suicide Attempts Among Youths," JAMA Psychiatry, Vol. 72, No. 11, November 2015, pp. 1143–1149.
- Hoffmire, Claire A., Shannon Grand. Barth, and Robert 1000. Bossarte, "Reevaluating Suicide Bloodshed for Veterans with Data from the VA-DoD Mortality Data Repository, 2000–2010," Psychiatric Services, Vol. 71, No. 6, June 2020, pp. 612–615.
- Hogan, Michael F., and Matthew Fifty. Goldman, "New Opportunities to Ameliorate Mental Wellness Crunch Systems," Psychiatric Services, Vol. 72, No. ii, February 1, 2021, pp. 169–173.
- Hostetter, Trisha A., Claire A. Hoffmire, Jeri E. Forster, Rachel Sayko Adams, Kelly Stearns-Yoder, and Lisa A. Brenner, "Suicide and Traumatic Brain Injury Amongst Individuals Seeking Veterans Health Assistants Services Betwixt Fiscal Years 2006 and 2015," Journal of Head Trauma Rehabilitation, Vol. 34, No. 5, September–Oct 2019, pp. E1–E9.
- Landes, Sara J., JoAnn E. Kirchner, John P. Areno, Mark A. Reger, Traci H. Abraham, Jeffery A. Pitcock, Mary J. Bollinger, and Katherine Anne Comtois, "Adapting and Implementing Caring Contacts in a Department of Veterans Affairs Emergency Department: A Pilot Study Protocol," Pilot and Feasibility Studies, Vol. v, October ten, 2019, commodity 115.
- Miller, Ivan W., Carlos A. Camargo, Jr., Sarah A. Arias, Ashley F. Sullivan, Michael H. Allen, Amy B. Goldstein, Anne P. Manton, Janice A. Espinola, Richard Jones, Kohei Hasegawa, and Edwin D. Boudreaux, "Suicide Prevention in an Emergency Section Population: The ED-Safety Study," JAMA Psychiatry, Vol. 74, No. vi, June 2017, pp. 563–570.
- Motto, J. A., and A. Thousand. Bostrom, "A Randomized Controlled Trial of Postcrisis Suicide Prevention," Psychiatric Services, Vol. 52, No. half dozen, June 2001, pp. 828–833.
- National Constitute of Mental Health, "Enquire Suicide-Screening Questions (ASQ) Toolkit," webpage, undated. As of May 2021: https://world wide web.nimh.nih.gov/research/enquiry-conducted-at-nimh/asq-toolkit-materials/
- O'Hanlon, Claire, Christina Huang, Elizabeth Sloss, Rebecca Anhang Price, Peter Hussey, Carrie Farmer, Courtney Gidengil, "Comparing VA and not-VA Quality of Intendance: A Systematic Review," Journal of General Internal Medicine, Vol. 32, No. 1, Jan 2017, pp. 105-121.
- Reger, Greg M., Mary Lou McClure, David Ruskin, Sarah P. Carter, and Mark A. Reger, "Integrating Predictive Modeling into Mental Health Care: An Instance in Suicide Prevention," Psychiatric Services, Vol. 70, No. 1, January 1, 2019, pp. 71–74.
- Reger, Mark A., Derek J. Smolenski, Nancy A. Skopp, Melinda J. Metzger-Abamukang, Han 1000. Kang, Tim A. Bullman, Sondra Perdue, and Gregory A. Gahm, "Risk of Suicide Among US Military Service Members Post-obit Performance Enduring Freedom or Functioning Iraqi Freedom Deployment and Separation From the Us Military," JAMA Psychiatry, Vol. 72, No. half dozen, June 2015, pp. 561-569.
- Roaten, Kimberly, Celeste Johnson, Russell Genzel, Fuad Khan, and Carol S. Northward, "Development and Implementation of a Universal Suicide Take chances Screening Program in a Prophylactic-Internet Hospital System," Joint Committee Periodical on Quality and Patient Safety, Vol. 44, No. 1, Jan 2018, pp. iv–11.
- SAMHSA—See Substance Abuse and Mental Health Services Administration.
- Schoenbaum, Michael, Ronald C. Kessler, Stephen E. Gilman, Lisa J. Colpe, Steven Thousand. Heeringa, Murray B. Stein, Robert J. Ursano, Kenneth L. Cox, for the ARMY STARRS Collaborators, "Predictors of Suicide and Accident Death in the Army Study to Assess Take chances and Resilience in Servicemembers (Army STARRS): Results From the Army Report to Assess Risk and Resilience in Servicemembers (Ground forces STARRS)," JAMA Psychiatry, Vol. 71, No. 5, May 2014, pp. 493-503.
- Stone, Deb, Kristin Holland, Brad Bartholow, Alex Crosby, Shane Davis, and Natalie Wilkins, Preventing Suicide: A Technical Bundle of Policy, Programs, and Practices, Atlanta, Ga.: Division of Violence Prevention, National Eye for Injury Prevention and Control, Centers for Illness Command and Prevention, 2017.
- Substance Abuse and Mental Health Services Administration, "Governor's and Mayor'southward Challenges to Prevent Suicide Amidst Service Members, Veterans, and Their Families," webpage, last updated Nov x, 2020. As of May 2021: https://world wide web.samhsa.gov/smvf-ta-center/mayors-governors-challenges
- Thom, Robyn, Charlotte Hogan, and Eric Hazen, "Suicide Risk Screening in the Hospital Setting: A Review of Brief Validated Tools," Psychosomatics, Vol. 61, No. 1, January–February 2020, pp. 1–7.
- U.S. Department of Veterans Affairs, National Strategy for Preventing Veteran Suicide, 2018–2028, Washington, D.C., 2018.
- ———, "VA Launches Plan to Transport Caring Letters to ninety,000 Veterans," press release, October 5, 2020a.
- ———, 2020 National Veteran Suicide Prevention Annual Written report, Washington, D.C., November 2020b.
- VA—See U.Due south. Department of Veterans Affairs.
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This Perspective is part of the "Veterans' Bug in Focus" series. Policy research has an important role to play in supporting veterans equally they transition to life after military service. This shift can exist challenging—from securing job opportunities and housing to coping with trauma and inability. Researchers at the RAND Epstein Family Veterans Policy Research Institute routinely assess the latest information on disquisitional issues affecting veterans, gaps in the cognition base, and opportunities for policy activity.
Funding for this publication was made possible by a generous gift from Daniel J. Epstein through the Epstein Family Foundation, which established the RAND Epstein Family Veterans Policy Research Institute in 2021. The plant is dedicated to conducting innovative, evidence-based research and analysis to improve the lives of those who have served in the U.Due south. military. Building on decades of interdisciplinary expertise at the RAND Corporation, the institute prioritizes creative, equitable, and inclusive solutions and interventions that see the needs of diverse veteran populations while engaging and empowering those who support them. For more information about the RAND Epstein Family Veterans Policy Research Establish, visit veterans.rand.org.
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