Veteran Suicide: Risk, Warning Signs & Prevention

Military veterans are among the most sensitive groups of people in the US regarding substance abuse disorders. They are particularly vulnerable once they leave active service and have to get on with their lives in a non-military environment. This is a particularly delicate period during which they try to reintegrate back into their everyday lives surrounded by families, friends, and wider community.1

This period of readjustment leaves them vulnerable to environmental stressors that are specific to former active military personnel, making them susceptible to an increased risk of substance use disorders (SUD). According to research, 70% of veterans underestimate their risks of overdose, further exacerbating the situation they find themselves in. Once military personnel leave active military service, their rates of illicit drug and alcohol use increases.2

Close to 11% of veterans meet the requirements for substance use disorder, meaning that 1 in 10 suffers from SUD which makes it a higher rate than that of the rest of the US population. As much as 65% of veterans that enroll into rehab programs cite alcohol as their substance of choice, whereas heroin is reported by 10.7% and cocaine by 6%. Unfortunately, these are some of the most dangerous substances when it comes to the risk of overdose and suicidal tendencies.1

What Leads Veterans to Commit Suicide?

Suicide is an act of people intentionally and successfully harming themselves in order to end their lives. In contrast to this, a suicide attempt is when their actions don’t go as planned for one reason or the other and they fail in taking their lives. Unfortunately, suicidal ideation and suicide deaths are a particularly widespread phenomenon in veteran communities far exceeding the average national levels.3

This is in part the result of many unique and stressful features of military service and especially life on the front lines. Military culture also plays a part because of its prevalence of macho attitudes that tend to overlook or ignore certain emotions or indicators of mental health issues. Added to this is the peer pressure that veterans and military personnel feel. This makes them anxious of potential exclusion from their communities due to being perceived as soft or weak.1

Some also feel discouraged to look for treatment fearing that such actions might have negative consequences for their potential of military advancement or future deployment. Such a complex situation that veterans find themselves in is exacerbated by previous risk factors that are present since their active military days. This makes them more prone to developing mental health issues like depression, SUD, co-occurring disorders, PTSD, TBI and in worst cases suicide.1

Veteran Suicide Statistics

In 2019, the number of suicides in the US was 45,861 representing a steep rise from 29,580 in 2001. In the same period suicides among American veterans were rising at a slower pace, going from 5,989 in 2001 to 6,261 in 2019. Positive as it is that the overall share of veteran suicides decreased from 20.2% to 13.7%, this number is still too big considering that veterans constitute 6.86% of American adult population according to the 2019 American Community Survey.4, 5

In 2016, for instance, the suicide rate was 1.5 times greater for veterans than for other adults adjusted for age and gender. There were 17.2 veteran suicides on average every day in 2019. Out of those 17.2 suicides per day, an estimated 6.8 were veterans who came into contact with Veterans Health Administration in 2018 or 2019, highlighting that more needs to be done on all fronts to tackle this issue.4

What Are Some of the Risk Factors for Suicide Among Veterans?

According to available data, suicide rate was the highest among active duty veterans, both deployed and non-deployed, for the first 3 years after leaving military service. Interestingly, deployed veterans were at a lower risk of death as a result of suicide than their non-deployed peers. This highlights how hard it is for veterans to get back to normal everyday existence once their military service ends.6

Difficulties associated with this transition are one of the factors that compel veterans to seek solace in self-medication through misuse of prescription drugs and ultimately substance abuse. Suicidal behavior among US military personnel is usually foreshadowed by substance abuse, with roughly 30% of suicides and over 45% of all suicide attempts that happened after 2003 being connected to some form of alcohol or drug use.1

Suicidal behavior is not straightforward and it’s even harder to predict. In most cases, individuals who appear to possess certain suicidal risk factors will never act on them and engage in suicide attempts. This makes it even more difficult to predict who will end up acting on their suicidal ideation. Some of the main risk factors for suicide are:3

Chronic pain, which might be a consequence of combat injury.
History of family violence or trauma, especially physical and sexual abuse.
Family history of a suicide, substance abuse, or other mental health disorders.
Mental health disorders, such as substance use disorder or co-occurring disorders (also known as dual diagnosis).
Depression, which can become very severe and result in suicidal ideation.
PTSD, which may be caused by stress, exposure to life-threatening situations or horrible scenes on the battlefield, and different types of traumas concerning the politics and aftermath of war.
Build up stress that can be hard for individuals to recognize.
Stigma that can prevent veterans from seeking treatment.
Falling out with close family members or friends, especially one from the military, might make veterans feel ostracized or unvalued.
Psychosocial stressors, including divorce, death of a loved one, terminal or incurable illness, displacement or loss of a job, and other intense or unnatural situations like natural disasters.
History of previous suicide attempts should always be considered as a major risk factor and even a possible warning sign of suicide.
Experience of having killed someone while deployed can be a hard thing to come to terms with and may trigger a whole series of unwanted mental health issues.

What Are the Warning Signs of Suicide for Veterans?

It can be hard sometimes to recognize the warning signs of suicide and differentiate them from risk factors. This is especially pronounced with people who move in small groups or spend a lot of their time alone. For this reason honest contact and thoughtful conversation are some of the best ways to gain insight into people’s feelings and discern their true mental condition.7

Warning signs for veteran suicides can be split in two categories. There are indirect warning signs that should raise your alertness levels and be followed closely, such as:7

Hopelessness, a general despair and a feeling that things won’t get better.
Purposelessness, when everything loses its meaning and there is no reason for living.
Anxiety and agitation that can be hard to shake off.
Mood changes and irritability that can make individuals socially unbearable.
Feelings of guilt and shame that can make people feel humiliated or severely distressed.
Sleep disturbances which can become a big problem if they are long-term.
Social withdrawal and avoidance interaction of people in favor of seclusion and isolation.
Anger, characterized by constant rage and confrontational behavior.
Recklessness and risky behavior which looks for dangerous situations.
Severe substance abuse, especially of substances that have the potential to willfully or accidentally end someone’s life like heroin, cocaine, alcohol, methamphetamines, opioids and other potentially deadly pills.

The second group are direct warning signs of suicide in veterans, which should be a cause for immediate action, including:7

Expressing a wish to die or commit suicide, talking, writing, or researching about the topic of suicide.
Buying or storing of items that can be used for suicide or searching the internet for possible methods of suicide.
Preparing for their own death through updating of wills, giving away possessions, making financial or other arrangements for children or parents, and saying goodbye to family members or close friends.

How Substance Abuse Leads Veterans to Commit Suicide?

Substance abuse itself is one of the factors that increase the chances of possible suicide. Individuals who suffered from substance use disorders had higher likelihood of attempting suicide at some point during their lives. Alcohol and drug problems are known to contribute to risky behavior and ultimately suicidal ideation. Substance abuse can exacerbate suicidal risk factors like the feeling of hopelessness, depressions, and impulsiveness, as well as cause anxiety and self-harm.8

Roughly 1.3 million veterans had substance use disorder, while 481,000 had both mental illness and SUD. Alcohol use disorder (AUD) was reported by 80% of veterans or about 1 million people. When it comes to drugs, there were 343,000 veterans who struggled with illicit drug use which is about 27%, and approximately 100,000 individuals who used both alcohol and drugs, or little less than 8%.9

Added to this are the difficulties that veterans experience between deployments or when returning to everyday civilian life. Data shows that repeated and extended deployments have a tendency to increase substance use disorders and other mental health issues. Symptoms of a substance use disorder can in certain cases appear years after discharge or termination of military service.10

Veterans and Mental Health

According to research, 3.1 million American veterans were suffering from mental health disorders in 2019. Serious mental health disorders were reported by 833,000 veterans but the alarming fact is that more than a quarter of them, some 26.8%, received no treatment at all. When it comes to SUD out of 1.3 million veterans, a staggering number of them, approximately 85%, also underwent no form of treatment.9

In addition to SUD, veterans mostly suffer from PTSD and/or depression. These two conditions often go together and have the potential to aggravate one another. Studies indicate that veterans with PTSD and some other comorbid conditions are harder to treat and may require longer rehabilitation programs. Comorbidities of PTSD, like depression and SUD, result in deficiency in social functioning, higher rates of suicide and lower willingness to stick with treatment.11

What Are the Risk Factors for PTSD?

Post-traumatic stress disorder (PTSD) is a mental health condition that can be triggered by first-hand traumatic events, like near-death experiences and situations of intense fear for one’s life or lives of loved ones. These types of events are characterized by loss of control over the proceedings and heightened stress and anxiety. They are a regular occurrence in the military and most veterans lived through at least some of those experiences.12

After these incidents pass, people usually try carrying on with their normal lives only to find that they have trouble sleeping, concentrating, and engaging in everyday activities like going to school or getting on with their work. Most people start feeling better after a period of time. But if after a few months things haven’t gotten better it might be a good idea to see a doctor.12

Most common risk factors that cause PTSD in veterans are:12

Combat or other military experiences.
Life-threatening situations, whether your own life or someone else’s.
Traumatic events like natural disasters or traffic accidents.
Sexual abuse.
Terrorist attacks.

What Suicide Prevention Treatment Options Are Available to Veterans?

It’s very important that medical professionals adopt a holistic approach when treating veterans and their families. This implies that doctors and other clinicians must take into account the specific needs of the veteran community and characteristic features associated with wider military culture. The passing of the Mission Act of 2018 further amended previous legislation from 2014 and improved access and treatment options for American veterans.10

Some of the treatment options that veterans have to choose from are:7

Inpatient rehab that is available in the form of short-term hospital programs and long-term residential rehabilitation options.
Outpatient rehabs that can be delivered in standard form which is very adjustable to individual needs of patients and more intense forms called Intensive outpatient treatments (IOT).
Medication-assisted treatments which combine the use of FDA-approved medication which helps with withdrawal symptoms and proven behavioral approaches that aim to provide whole-patient care.
Self-help groups, sometimes called mutual support groups, like Alcoholics Anonymous and Narcotics Anonymous which utilize 12-step programs.

The Department of Veteran Affairs ran 228 facilities in 2020 according to the National Survey conducted by SAMHSA. All of those facilities offered suicide prevention programs, 93 % provided suicide risk evaluation, 93% had suicide risk screening services, and 90% conducted evidence-based suicide prevention interventions.13

There are two easy ways veterans can look into their local and nationwide rehab options. They can find VA locations or in-network community care providers based on the address by browsing the type of facility and service offered using Find Locations map on the VA website.14 Or they can browse facilities by the state and administration on the interactive map of the United States.15

How to Connect Veterans With Suicide Hotlines?

Veterans are faced with many barriers on the road to SUD treatment. The most common barriers veterans cite are transportation, funding, awareness, and knowledge about Veterans Administration and its activities. In every state, including the smallest ones, transportation was identified as a major barrier to treatment, whether for financial reasons or because vehicle transport itself is identified as a trigger.10

Hotlines are one of the best tools for raising awareness and providing veterans with information about their treatment options and warning signs they should pay close attention to. Since hotlines for veterans are in many cases staffed with their former peers they can be a good outlet for veterans giving them the option to talk with somebody who understands what they are going through, who relates with their unique experiences and existing issues.

The U.S. Department of Veterans Affairs runs a hotline that doesn’t require prior enrollment in VA benefits or health care to connect. It is available 24/7, guarantees privacy to callers, and offers chat or text options for those who don’t feel like they are ready to talk. Crisis line responders serve veterans, their families, and friends and offer suicide prevention advice and counseling.16

Identifying Signs of Suicide in Veterans & How to Help