United States military veteran suicide

United States military veteran suicide[1][2] is an ongoing phenomenon regarding a reportedly high rate of suicide among U.S. military veterans, in comparison to the general public.[3] According to the most recent report published by the United States Department of Veterans Affairs (VA) in 2016, which analyzed 55 million veterans' records from 1979 to 2014, the current analysis indicates that an average of 20 veterans a day die from suicide.[4]

Background

In 2012 alone, an estimated 7,500 former military personnel died by suicide. More active duty veterans, 177, succumbed to suicide that year than were killed in combat, 176. The Army suffered 52% of the suicides from all branches.[1]

In 2013, the VA released a study that covered suicides from 1999 to 2010, which showed that roughly 22 veterans were dying by suicide per day, or one every 65 minutes.[5] Some sources suggest that this rate may be undercounting suicides.[6] A recent analysis found a suicide rate among veterans of about 30 per 100,000 population per year, compared with the civilian rate of 14 per 100,000.[6][7] However, the comparison was not adjusted for age and sex.

The total number of suicides differs by age group; 31% of these suicides were by veterans 49 and younger while 69% were by veterans aged 50 and older.[8] As with suicides in general, suicide of veterans is primarily male, with about 97 percent of the suicides being male in the states that reported gender.[7]

In 2015, the Clay Hunt Veterans Suicide Prevention Act passed in the Senate[9] and was then enacted as Pub.L. 114–2 on February 12, 2015.

Annual number of suicides per 100,000 population. 2000-2010.[10][11]
Never served
in military		 Veterans and
active service
Women 5.2 28.7
Men 20.9 32.1

In August 2016, the VA released a new report which consisted of the nation's largest analysis of veteran suicide. The report reviewed more than 55 million veterans' records from 1979 to 2014 from every state in the nation. The previous report from 2012 was primarily limited to data on veterans who used VHA health services or from mortality records obtained directly from 20 states and approximately 3 million records. Compared to the data from the 2012 report, which estimated the number of Veteran deaths by suicide to be 22 per day, the current analysis indicates that in 2014, an average of 20 veterans a day died from suicide.[12]

In May 2019, President Donald Trump signed an executive order, called the PREVENTS Initiative, to counter the national tragedy of suicide. [13] The initiative aims to equip state and local governments with the resources necessary to identify and intervene in scenarios where United States Veterans may be at risk to suicide. In the past, the Veteran's Administration and other federal agencies, relied upon the veteran to self-identify when needing help. The new initiative attempts to bring public awareness of the veteran's struggle associated with service. The president successfully secured a record $73.1 billion dollars for veteran health services. [14] Included in the $73.1 billion funding is $8.6 billion towards mental health services. [15]

Social policy: history of veteran suicide prevention

The first suicide prevention center in the United States was opened in Los Angeles in 1958 with funding from the U.S. Public Health Service. In 1966, the Center for Studies of Suicide Prevention (later the Suicide Research Unit) was established at the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH). Later on, in 1970, the NIMH pushed in Phoenix the discussion about the status of suicide prevention, presented relevant findings about suicide rate and identified the future directions and priorities of the topic.[16]

However, it wasn't until mid-1990s when suicide started being the central issue of the political-social agenda of the United States. Survivors from suicide began to mobilize encouraging the development of a national strategy for suicide prevention. Finally, two Congressional Resolutions—S. Res. 84 and H. Res. 212 of the 105th Congress—recognized suicide as a national problem and suicide prevention as a national priority.[16]

As recommended in the U.N. guidelines, these groups set out to establish a public and private partnership that would be responsible for promoting suicide prevention in the United States. This innovative public-private partnership jointly sponsored a national consensus conference on suicide prevention in Reno, Nevada, which developed a list of 81 recommendations[16]

Key points from Reno, Nevada, conference
  1. Suicide prevention must recognize and affirm the value, dignity, and importance of each person.
  2. Suicide is not solely the result of illness or inner conditions. The feelings of hopelessness that contribute to suicide can stem from societal conditions and attitudes. Therefore, everyone concerned with suicide prevention shares a responsibility to help change attitudes and eliminate the conditions of oppression, racism, homophobia, discrimination, and prejudice.
  3. Some groups are disproportionately affected by these societal conditions, and some are at greater risk for suicide.
  4. Individuals, communities, organizations, and leaders at all levels should collaborate to promote suicide prevention.
  5. The success of this strategy ultimately rests with individuals and communities across the United States.[16]

Federal policy initiatives

One of the most important laws about Veterans' Suicide Prevention is the Joshua Omvig Veterans Suicide Prevention Act (JOVSPA) of 2007, supporting the creation of a comprehensive program to reduce the incidence of suicide among veterans. Named for a veteran of Operation Iraqi Freedom who died by suicide in 2005, the act directed the Secretary of the U.S. Department of Veterans Affairs (VA) to implement a comprehensive suicide prevention program for veterans. Components include staff education, mental health assessments as part of overall health assessments, a suicide prevention coordinator at each VA medical facility, research efforts, 24-hour mental health care, a toll-free crisis line, and outreach to and education for veterans and their families. In the summer of 2009, VA added a one-to-one “chat service” for veterans who prefer to reach out for assistance using the Internet.[16]

In 2010, the National Action Alliance for Suicide Prevention was created and, in 2012, the National Strategy was revised. With Obama’s administration suicide prevention strategies for veterans expanded and a goal was formed to make the process of finding and obtaining mental health resources easier for veterans, work to retain and recruit mental health professionals, and make the government programs more accountable for the people they serve.[17][18]

Prevention hotline

In 2011, the National Veterans Suicide Prevention Hotline was renamed the Veterans Crisis Line (VCL).[19] The primary mission of the VCL is “to provide 24/7, world-class suicide prevention and crisis intervention services to Veterans, Servicemembers, and their family members.”[20] The VCL faces a number of challenges. It must meet the operational and business demands of responding to over 500,000 calls per year, along with thousands of electronic chats and text messages, and initiating rescue processes when indicated. It must also train staff to respond to Veterans and their family members in individual encounters during which a responder must make an accurate assessment of the needs of the caller under stressful, time-sensitive conditions.

Since its inception in July 2007, the VCL has answered over three million calls and initiated the dispatch of emergency services to callers in imminent crisis over 84,000 times. Since launching chat in 2009 and text services in November 2011, the VCL has answered nearly 359,000 and nearly 78,000 requests for chat and text services, respectively. In addition, staff has forwarded more than 504,000 referrals to local VA Suicide Prevention Coordinators on behalf of Veterans to ensure continuity of care with Veterans’ local VA providers. For FY 2016, more than 51,000 chats and 17,000 texts were answered by VCL responders. For FY 2017, nearly 54,000 chats and nearly 16,000 texts were answered by VCL responders. Emergency services were dispatched to over 12,000 callers in immediate crisis in FY 2016, and nearly 19,000 callers in immediate crisis in FY 2017. For FY 2016, nearly 87,000 referrals were made to local Suicide Prevention Coordinators for follow-up care and over 95,000 referrals were made in FY 2017.[21]

Federal budget

The 2018 federal budget expanded mental health screenings for veterans.[22]

Causes

A study published in the Cleveland Clinic Journal of Medicine found that,

Combat veterans are not only more likely to have suicidal ideation, often associated with posttraumatic stress disorder (PTSD) and depression, but they are more likely to act on a suicidal plan. Especially since veterans may be less likely to seek help from a mental health professional, non-mental health physicians are in a key position to screen for PTSD, depression, and suicidal ideation in these patients.

The same study also found that in veterans with PTSD related to combat experience, combat-related guilt may be a significant predictor of suicidal ideation and attempts.[23]

Craig Bryan of the University of Utah National Center for Veterans Studies said that veterans have the same risk factors for suicide as the general population, including feelings of depression, hopelessness, post-traumatic stress disorder, a history of trauma, and access to firearms.[7]

A study done by the Department of Veterans Affairs discovered that veterans are more likely to develop symptoms of PTSD for a number of reasons such as:

  • Longer times at war
  • Lower level of education
  • More severe combat conditions
  • Other soldiers around them killed
  • Brain/head trauma
  • Female gender
  • Life lasting physical injuries
  • Military structure

The Department of Veterans Affairs also discovered that where a soldier was deployed and which branch of military they were with could also have drastic effects on their mental status after returning from service. As in most combat wars, their experiences would vary depending on where they were stationed.[24]

Combat Stressors Seeing dead bodies Being shot at Being attacked/ ambushed Receiving rocket or mortar fire Knowing someone killed/ seriously injured
Iraq Army 95% 93% 89% 86% 86%
Iraq Marines 94% 97% 95% 92% 87%
Afghanistan Army 39% 66% 58% 84% 43%

For many service members, being away from home for long periods of time can cause problems at home or work. These problems can add to the stress. This may be even more so for National Guard and Reserve troops who had not expected to be away for so long. Almost half of those who have served in the current wars have been Guard and Reservists.

— Department of Veterans Affairs, https://www.ptsd.va.gov/public/ptsd-overview/reintegration/overview-mental-health-effects.asp

Critics of this reporting such as author Tim Worstall in Feb. 2013 claim that there is no epidemic when comparing similar demographic cohorts in the civilian population. He points out that since vets are predominantly male, the suicide rate to compare to is not the general civilian rate, but the rate for males.[25]

Protective factors

Veterans can have difficulty transitioning from the military to civilian life. Many choose to transition by utilizing their GI Bill or other education benefits.[26] The pursuit of education often facilitates the transition to civilian life. The pursuit of education among veterans can aggravate post service conditions that are linked to a higher likelihood of suicide but often aids in the transition to civilian life[27][28] Veterans pursuing education, especially those utilizing the post 9/11 GI Bill, are more likely to have protective factors related to socialization and reintegration than those who are not.[29]

  • Difficulty relating to fellow students
  • Difficulty in coping with military experiences in an academic environment
  • Lack of support or understanding for service connected disabilities
  • Negative stigmas related to military service
  • Feelings of isolation
  • Feelings of separation
  • Lack of social support
  • Difficulty with stable or reliable income
  • Difficulty with stable housing

Although higher education has presented many difficulties to returning veterans, research supports that veterans often benefit from transitioning from the military into higher education.[27] Academic life often requires student veterans to work and interact with other classmates. Most academic institutions have student veteran organizations and resources centers specifically to aid military veterans. Military education benefits, primarily the Post 9/11 GI Bill, pay the cost of tuition and provide a housing stipend to student veterans. Education benefits often give veteran students an income,[27] a goal to continue to work towards and socialization with the general population.[30]

The suicide rates of veterans is on a downward trend but not a significant one. Veterans have many mental healthcare opportunities and availability of treatment however, finding the much-needed individualized treatment remains a work in progress. The approach to mental healthcare for veterans is not consistent. There are some branches with more proactive measures to reduce the stigma and promote mental well-being and the need is becoming painfully more and more clear. Coordination through various mental health facilities, primary care providers and the Veterans Association is not mandated to the extent it needs to be. The trend of a broader spectrum treatment approach is primarily used nationwide. Promoting individualized treatment and mental health care prior to discharge is a large step in the right direction. The more that can be done to enable veterans to attend the various forms of mental health treatment while still giving them a purpose to succeed will improve the sustainability of longer term treatment plans. Communicating the many options and different types of mental health treatment will help to encourage veterans to participate in mental health treatment by eliminating the stigmas associated with getting help. The majority of veterans are trained to be resilient and will rarely ask for help. They need to know that it is ok to ask for help when it comes to their mental health. Many non-profit organizations exist to promote awareness in local communities, such as Wingman Project and 22Kill.

See also

References
  1. February 1, 2013. Ed Pilkington. US military struggling to stop suicide epidemic among war veterans. The Guardian. Retrieved: 23 May 2014.
  2. April 3, 2014. Jordain Carney. . National Journal. Retrieved: 23 May 2014.
  3. January 10, 2014. Denver Nicks. Report: Suicide Rate Soars Among Young Vets. "The suicide rate among veterans remains well above that for the general population, with roughly 20 former servicemen and women committing suicide every day." TIME. Retrieved: 23 May 2014.
  4. "Suicide Among Veterans and Other Americans 2001–2014" (PDF). Mentalhealth.va.gov. Retrieved 1 June 2019.
  5. February 1, 2013. U.S. military veteran suicides rise, one dies every 65 minutes. Reuters. Retrieved: 23 May 2014.
  6. Moni Basu, Why suicide rate among veterans may be more than 22 a day, CNN, November 14, 2013. Retrieved: 25 December 2014
  7. Jeff Hargarten, Forrest Burnson, Bonnie Campo and Chase Cook, Veteran Suicides Twice as High as Civilian Rates, News21, Aug. 24, 2013. Retrieved: 25 December 2014.
  8. February 5, 2013. Melanie Haiken. Suicide Rate Among Vets and Active Duty Military Jumps - Now 22 A Day. Forbes. Retrieved: 23 May 2014.
  9. "Clay Hunt veterans suicide prevention act passes in Senate, will head to White House".
  10. Zarembo, Alan (2015-06-08). "Suicide rate of female military veterans is called staggering". LA Times. Retrieved 2016-07-18.
  11. Changes in Suicide Mortality for Veterans and Nonveterans by Gender and History of VHA Service Use, 2000–2010. By Claire A. Hoffmire, Ph.D., Janet E. Kemp, R.N., Ph.D., Robert M. Bossarte, Ph.D.. Published online: May 01, 2015. Psychiatric Services, Volume 66 Issue 9, September 01, 2015, pp. 959-965. doi:10.1176/appi.ps.201400031.
  12. "VA Releases Report on Nation's Largest Analysis of Veteran Suicide". Office of Public and Intergovernmental Affairs. Retrieved 9 September 2016.
  13. "President Donald J. Trump Issues a National Call to Action to Empower Veterans and End the National Tragedy of Veteran Suicide". The White House. Retrieved 2019-10-13.
  14. "President Donald J. Trump Issues a National Call to Action to Empower Veterans and End the National Tragedy of Veteran Suicide". The White House. Retrieved 2019-10-13.
  15. "President Donald J. Trump Issues a National Call to Action to Empower Veterans and End the National Tragedy of Veteran Suicide". The White House. Retrieved 2019-10-13.
  16. (us), Office of the Surgeon General; (us), National Action Alliance for Suicide Prevention (2012-09-01). Brief History of Suicide Prevention in the United States. US Department of Health & Human Services (US).
  17. Baker, Peter (2015-02-12). "Obama Signs Suicide Prevention for Veterans Act Into Law". The New York Times. ISSN 0362-4331. Retrieved 2017-05-16.
  18. "Presidential Proclamation -- World Suicide Prevention Day, 2016". whitehouse.gov. 2016-09-09. Retrieved 2017-05-16.
  20. VCL Mission Statement
  22. Shane, Leo (March 22, 2018). "Budget omnibus includes new mental health care for other-than-honorable vets". Military Times. Retrieved May 28, 2018.
  23. Leo Sher, MD. Maria Dolores Braquehais, MD, PhD. Miquel Casas, MD, PhD. Posttraumatic stress disorder, depression, and suicide in veterans. doi:10.3949/ccjm.79a.11069. Cleveland Clinic Journal of Medicine. February 2012. vol. 79 2 92-97. Retrieved: 25 May 2014.
  24. "Mental Health Effects of Serving in Afghanistan and Iraq - PTSD: National Center for PTSD". www.ptsd.va.gov. Retrieved 2018-05-02.
  25. But There Isn't An Epidemic Of Suicide In The US Military. By Tim Worstall. Feb 2, 2013. Forbes.
  26. Ostovary, Fariba; Dapprich, Janet (December 2011). "Challenges and opportunities of Operation Enduring Freedom/Operation Iraqi Freedom veterans with disabilities transitioning into learning and workplace environments". New Directions for Adult and Continuing Education. 2011 (132): 63–73. doi:10.1002/ace.432. ISSN 1052-2891.
  27. Elliott, Marta; Gonzalez, Carlene; Larsen, Barbara (July 2011). "U.S. Military Veterans Transition to College: Combat, PTSD, and Alienation on Campus". Journal of Student Affairs Research and Practice. 48 (3): 279–296. doi:10.2202/1949-6605.6293. ISSN 1949-6591.
  28. Holland, Jason M.; Malott, Jesse; Currier, Joseph M. (2013-12-05). "Meaning Made of Stress among Veterans Transitioning to College: Examining Unique Associations with Suicide Risk and Life-Threatening Behavior". Suicide and Life-Threatening Behavior. 44 (2): 218–231. doi:10.1111/sltb.12061. ISSN 0363-0234.
  29. Castro, Carl A.; Kintzle, Sara; Hassan, Anthony M. (2015). "The combat veteran paradox: Paradoxes and dilemmas encountered with reintegrating combat veterans and the agencies that support them". Traumatology. 21 (4): 299–310. doi:10.1037/trm0000049. ISSN 1085-9373.
  30. Smith, Natesha. Complexities of culture : understanding the identity of female veterans transitioning from military to college (Thesis). University of Louisville. doi:10.18297/etd/1353.

 This article incorporates public domain material from the United States Department of Health and Human Services website https://www.surgeongeneral.gov/library/reports/national-strategy-suicide-prevention/full-report.pdf.

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