Like in the general population, social support is a significant protective factor. Relationships with family and friends can prevent individuals from considering suicide to solve their problems. Studies show that Veterans who had good social support during and post-deployment had more positive mental health outcomes, including lower rates of SI. However, even with solid social support, individuals must have the social skills to ask for help when they need it. Given that social supports mitigate suicide risk, it is vital to assess Veterans for the presence of social connections. 74 Research also shows that Veterans with a greater sense of purpose have more resilience, which reduces the odds of suicidality. In addition, engagement in religion or spirituality has also been associated with decreased risk for SI in Veterans. Other protective factors include employment, meeting basic needs, self-care, living stability, social support, resilience, and self-determination) .71 An approach to clinical interviewing should include questions about protective factors. Not only do these questions carry less stigma than questions about suicide or self-harm behavior, but identifying protective factors for suicide in Veterans encourages the healthcare provider to focus on the individual’s competence in various domains of basic functioning. 71 Service Members and Veteran Intervention Strategies As a healthcare worker, knowledge regarding available resources is important for referrals and resources to individuals we meet. The Veterans Administration Health Service Department has implemented several programs to aid Veterans at risk for suicide or who have attempted suicide previously. The VA’s mission is to end Veteran suicide by implementing a public health approach that combines community-based and clinically based strategies across prevention, intervention, and postvention areas of focus. 68 Suicide Prevention 2.0 (SP 2.0). Suicide Prevention 2.0 is comprised of a dual effort, intervening on the community level and in the clinical care setting. The community-based intervention component reaches Veterans inside and outside the VA system by collaborating with other agencies. 72 It aims to: 1) identify Service members, Veterans, and their families and screen everyone for suicide risk; 2) promote connectedness and improve care continuity; and 3) decrease lethal means and safety planning. The clinical approach focuses on disseminating evidence-based psychotherapies to Veterans in need. The VA is currently hiring over 100 clinicians across 140 healthcare systems to provide mental health services to Veterans. 68 Now Initiative. The Now Initiative’s goal is to initiate evidence-based interventions to impact Veterans most efficiently at high-risk of suicide within one year. Its areas of focus include 1) lethal means safety; 2) suicide prevention in medical populations; 3) outreach to prior Veteran Health Administration (VHA) users; 4) suicide prevention program enhancements; and 5) paid media. 67
Table 10. Military Suicide Counts and Rates
Military Population / Service
2020 Count
2020 Rate
Active Component
384 175
28.7 36.4 19.3 33.9 24.3 21.7 22.2
Army Navy
66 62 81 77
Marine Corps
Air Force Reserve
Army Navy
142
13 10 12
- - -
Marine Corps
Air Force
National Guard
119 103
27.0 30.9
Army
Air Force - Note. Adapted from U.S. Department of Defense, Under Secretary of Defense for Personnel and Readiness. (2021). CY 2020 annual suicide report. https://www.dspo.mil/Portals/113/Documents/CY20%20Suicide%20Report/CY%20 2020%20Annual%20Suicide%20Report.pdf 68 16
From 2001 to 2019, there were increases in the percentage of Veteran suicide deaths involving firearms and suffocation, as well as decreases for those due to poisoning or “other means”. In 2019, firearms were used in 70% of male Veteran suicides and 50% of female Veteran suicides. 67 Veteran Risk Factors The Veteran population has unique risk factors that contribute to the higher suicide rates. 69 Multiple studies have shown that the following factors increase the risk of suicide for Veterans 69,71,72,73 : • Anger, rage, mood swings, and episodes of anxiety and agitation. • Expressing feelings of having no reason to live. • Seven adverse social determinants of health are strongly associated with SI and suicide attempts in Veterans: violence, housing instability, financial or employment problems, legal problems, familial or social problems, lack of access to health care and transportation, and nonspecific psychosocial needs. • A chart review conducted in 2012 found that approximately half of Veterans who died by suicide had a sleep disturbance such as insomnia. • Sexual dysfunction is common in people with post-traumatic stress disorder (PTSD). In male Veterans, decreased sexual pleasure and frequency of sexual intercourse is linked to more suicidal thoughts. In female Veterans, increased sexual frequency is linked to increased suicidal thoughts. • Mental health conditions like anxiety disorders, manic-depressive disorders, depressive disorders, and PTSD. Research at the Syracuse Medical Center found that 40% of Veterans with anxiety had at least one risk factor for suicide.
They also found that Veterans with a positive depression screen were at high risk for suicide. • Research has established links between TBIs and suicidality. Veterans who sustained a deployment-related TBI are at greater risk for suicide than those without TBI diagnoses. • Substance abuse, especially heavy binge drinking. In general, individuals who abuse drugs or alcohol are more likely to be depressed, have financial or social issues and engage in impulsive and high-risk behaviors. In 2017, researchers found that Veterans who abuse drugs or alcohol are twice as likely to die by suicide than other Veterans. • Veterans and Service Members who have been exposed to suicide are at elevated risk for suicide themselves. • Over 40% of Veterans experience difficulty when transitioning from military life to civilian life. Studies show these individuals are five times more likely to experience SI. Evidence-Based Practice: A study in 2020 examining VA patient data determined that social determinants of health, including violence, housing instability, and financial problems, increased the risk of suicide in Veterans.67 Each adverse factor increased a Veteran’s odds of suicidal ideation by 67% and a suicide attempt by 49%. Protective Factors Related to Veterans and Military Personnel Protective factors within a population reduce the probability amidst the increased risk. Protective factors are less frequently investigated and, therefore, lack empirical support as risk factors; however, several research studies report encouraging results.
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