Suicides among veterans: searching for factors

Suicide among U.S. military veterans became a rising concern during the era of the Afghanistan War and the Iraq War, begun in 2001 and 2003 by the Walker Bush administration. Sens. Daniel Akaka (D, HI), Patty Murray (D, WA) and Tom Harkin (D, IA) called attention to the crisis in 2008, claiming the Department of Veterans Affairs was trying to ignore a growing problem.

Sen. Harkin had filed a bill the previous year asking the department to document suicides among veterans and take steps to prevent them. About eight years passed before the issue gained traction. Democrats in Congress continued to seek action, while Republicans who supported the Iraq War resisted. As a last blast before retiring, in late 2014 former Sen. Tom Coburn (R, OK)–an anti-abortion, “gun rights” reactionary–blocked the major bill then in Congress, using a procedural foil.

The Clay Hunt Suicide Prevention for American Veterans Act (PL 114-2) was soon refiled, passed and signed into law by former Pres. Obama. It stimulated research at the Department of Veterans Affairs and improved access to help at federal facilities. It also opened the door to new efforts aimed at understanding the effects of war stresses on military personnel.

Searching for factors: Reacting to early criticism, the Department of Veterans Affairs had published a 2012 report on veteran suicides, but it was pockmarked with missing information and did not measure impacts and trends clearly. Renewed research led to a more comprehensive report released in August, 2016, and to publication of data organized by states in September, 2017.

The newly published data have attracted interest: the first organized and detailed information available from the Department of Veterans Affairs. The 2016 report focused on veterans enrolled in programs operated by the department. However, in a chart–without numerical data–it also showed that the ratio of veteran to civilian suicides remains high and rose steadily between 2003 and 2008, as critics in Congress had charged. [Figure 14, page 25]

Ratios of veteran to civilian suicides by years

VeteranCivilianSuicideRatio2001-2014
Source: U.S. Department of Veterans Affairs

On average, in 2001 military veterans were about 15 percent less likely than civilians to commit suicide. By 2009, they were about 20 percent more likely to commit suicide. Throughout, the veterans who enrolled in federal services (shown as “VHA Veteran”) have been more likely to commit suicide than the veterans who were not enrolled. Wars in Afghanistan and Iraq associated with increases in veteran suicides. Uses of federal services also associated with increases in veteran suicides.

State factors: The most recently released data, grouped by states where veterans who committed suicide were living, make it possible to look for other factors. The states reporting the lowest rates of veteran suicides during 2001 through 2014 were Massachusetts, Maryland, Rhode Island, New Jersey, and Connecticut–about 22 to 26 suicides per year per 100,000 veterans. The states reporting the highest rates were Montana, Utah, New Mexico, Nevada and Wyoming–about 69 to 55 per year, around 2-1/2 times as much as the states reporting the lowest rates.

The Department of Veterans Affairs released state data at 5 pm on a Friday afternoon. The few reporters from mainstream media who were paying attention noticed high suicide rates in Mountain West states. Some speculated that rural isolation might be a factor. None compared suicide rates quantitatively with the characteristics of states.

Characteristics of states are unlikely to be strong factors in veteran suicide rates, because they cannot identify impacts on the lives of individual veterans. For example, higher state spending on mental health services might be associated with a lower suicide rate, but it could have impact only if the services were actually being used by veterans. In fact, an analysis showed no statistically significant relation.

Since motor vehicle accidents may involve reckless and destructive behaviors, their impact was examined. Motor vehicle fatality rates have been collected and reported by federal agencies since the 1920s. So far, that has turned out to be the strongest state factor found associated with veteran suicides.

Veteran suicide versus motor vehicle fatality rates

VeteranSuicideVsMotorVehicleDeathRates
Source: U.S. Department of Veterans Affairs

Source: U.S. Centers for Disease Control and Prevention

Two other state factors produced statistically significant associations: percents of households reported as containing loaded guns and percents of state populations living in rural areas. Data on loaded guns were collected in a 2002 survey reported in a medical journal. Data on rural populations came from the 2010 federal census.

Correlations (R) with veteran suicide rates

MV death rates….0.50

Loaded guns…….0.43

Percent rural…..0.40

Sources: as described in text

The state factors are not statistically independent. Together they account for less than 40 percent of the state-to-state variance in veteran suicide rates. Although they can provide some insight, effective ways to prevent veteran suicides will likely develop from considering individual circumstances.

– Craig Bolon, Brookline, MA, September 19, 2017


Suicide rates of U.S. military veterans, 2001 through 2014, per 100,000 per year, Brookline Beacon, September 19, 2017

Thomas E. Ricks, Veterans Administration throws suicide stats out the back door on Friday at 5 pm, Foreign Policy, September 18, 2017

Hope Yen, Associated Press, Suicide among veterans highest in western U.S. and rural areas, ABC News, September 16, 2017

Suicide among veterans, state data sheets, U.S. Department of Veterans Affairs, September 15, 2017

Suicide among veterans and other Americans 2001-2014, U.S. Department of Veterans Affairs, August 3, 2016

Lauren M. Denneson et al., Suicide risk documented during veterans’ last Veterans Affairs health care contacts prior to suicide, Military Behavioral Health 5(1):1-119, 2016

Dave Philipps, Senate approves research into combat effects on mental health, New York Times, November 12, 2015

Kimberly Leonard, Obama signs suicide prevention bill to aid veterans, U.S. News, February 12, 2015

Richard A. Oppel, Jr., Preventing suicides among veterans is at center of bill passed by Senate, New York Times, February 4, 2015

Rep. Timothy Walz, Clay Hunt Suicide Prevention for American Veterans Act, H.R. 203 of the 114th Congress, PL 114-2, U.S. House of Representatives, filed January 7, 2015

Motor vehicle fatality rates per 100,000 persons per year for calendar 2014, U.S. Centers for Disease Control and Prevention, 2015

Leo Shame, III, GOP senator blocks vets’ suicide prevention bill, USA Today, December 16, 2014

Janet Kemp and Robert Bossarte, Suicide data report, U.S. Department of Veterans Affairs, 2012

State urban and rural population percentages, 2010 Census of Population, U.S. Bureau of the Census

Associated Press, VA official accused of covering up suicide rates, NBC News, April 24, 2008

Sen. Tom Harkin, Joshua Omvig Veterans Suicide Prevention Act, S. 479 of the 110th Congress, U.S. Senate, filed February 1, 2007

Catherine A. Okoro et al., Prevalence of household firearms and firearm-storage practices in the 50 states and the District of Columbia, Pediatrics 116(3):370-376, 2005

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