In the United States, suicide is the 10th leading causes of death, and it is very preventable. According to the American Foundation for Suicide Prevention (AFSP), on average, one American dies every 12.3 minutes by committing suicide. Men are much more likely to commit suicide than women, with four men to every one woman who commits suicide. About 43,000 Americans die from suicide every year.

The Centers for Disease Control and Prevention (CDC) reported that, between 1999 and 2014, rates of suicide across the US rose. Over 22 percent of the annual suicides in the United States are veterans of the US Armed Forces. Ninety percent of those who die due to suicide also have a diagnosable mental health disorder at the time of their death.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), there are 23.4 million US military veterans, 2.2 million active service members, and 3.1 million immediate family members. Veterans are more likely than the civilian population to develop specific mental health problems, like post-traumatic stress disorder, depression, and traumatic brain injury; they are also at higher risk for developing associated substance use disorders. Both of these conditions contribute to an increased risk of suicide among US military veterans.

Despondent young soldier covering his face with hands.

SAMHSA reports that at least half of the returning service members who need treatment for mental health struggles like PTSD look for help, but few receive adequate care. The suicide rate among current and former service members reached an all-time high in 2012, leading to an in-depth study on the problem.

Suicide and US Armed Forces Veterans

Between 2005 and 2009, over 1,100 service members took their lives, which was an average of one suicide every 36 hours. At the same time, in 2009, mental health and substance abuse struggles caused the hospitalization of more current and former troops than any other cause.

According to the most recent comprehensive report from Veterans Affairs Administration (VA):

  • An average of 20 veterans died every day in 2014 due to suicide.
  • Six of those 20 deaths were recent users of VA hospital services.
  • Although veterans make up 8.5 percent of the US adult population, veteran deaths by suicide makes up 18 percent of all suicide deaths annually.
  • About 67 percent of veteran suicide deaths involve firearms.
  • Approximately 65 percent of veterans who died due to suicide in 2014 were 50 or older.
  • The risk of suicide among male veterans is 19 percent higher compared to adult male civilians.
  • Suicide risk among female veterans is 2.5 times higher than among female civilians.
  • In 2014, veterans who were 18-29 years old had the highest rate of suicides.
  • Rates of suicide among all veterans who use VA services have remained relatively stable, although rates have gone slightly up among women and slightly down among men.
  • Female veterans are more likely to have access to and use firearms, which is associated with their increased risk of suicide.

Although many veterans who seek help, and many who receive it, still struggle with suicidal ideation, suicide attempts, or death from suicide, the VA noted that 70 percent of veterans who lost their lives due to suicide had not been connected to healthcare through the VA. Access to evidence-based help from physicians, therapists, and addiction specialists can reduce the risk of suicide by treating underlying causes.

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Risks and Warning Signs of Suicide in Veterans

The reasons behind suicidal ideation or attempts are complex, but among veterans, the most commonly cited triggers leading to an increased suicide risk include:

  • Living predominantly in rural areas, so experiencing more social isolation
  • Limited access to healthcare
  • Gun ownership
  • Increased risk of mental health and substance use disorders, especially opioid addiction

It is important to know the signs of a potential suicide attempt in veterans. These may include:

  • Loss of sleep
  • Anxiety, agitation, irritability, or mood swings
  • Feeling like there’s no reason to live
  • Anger or rage
  • Engaging in risky behaviors, like drunk driving
  • Increased drinking or drug abuse
  • Withdrawing from family or friends
  • Talking about suicide or wanting to die
  • Looking for ways to attempt suicide, like obsessively maintaining firearms
  • Feeling like there is no purpose in life
  • Other self-destructive behaviors or an obsession with death

Substance Abuse Increases the Risk of Suicide among Veterans

In both military service members and the civilian population, substance abuse increases the risk of suicidal ideation, suicide attempts, and completed suicide. Several studies have found that suicidal ideation is higher among people with depression who drink alcohol; lower drinking age increases the risk of deaths by suicide among young adults; and people who had a depressive disorder and a substance abuse disorder were much more likely to have at least once suicide attempt in their lives. Veterans with problems abusing drugs or alcohol are twice as likely to die from suicide compared to civilians.

The highest rates of suicide among veterans occur among people who abuse specific drugs like:

  • Prescription sedatives
  • Opioids
  • Alcohol

Many have specific mental disorders, such as:

  • Depression
  • PTSD
  • Bipolar disorder
  • Schizophrenia

A study on veterans and risks for suicide found that 75.6 out of 100,000 veterans with a diagnosed substance use disorder completed suicide compared to 34.7 out of 100,000 veterans overall. Sedative abuse increased the risk greatly, as 171.4 per 100,000 veterans died due to suicide. Women who misused opioid drugs were very high risk, with 98.4 out of every 100,000 dying from suicide. Male veterans who misused amphetamines also had a high rate of suicide, at 95 out of every 100,000.

The VA reports that two out of every 10 veterans with PTSD has a co-occurring substance use disorder. Conversely, one out of every three veterans seeking treatment for substance abuse has PTSD. Among returning veterans from Iraq and Afghanistan, one in 10 going to the VA for treatment will have a problem abusing drugs or alcohol.

The VA reports that the percentage of veterans receiving care through the VA healthcare system for mental health and substance use disorders has increased. In 2001, 27 percent of patients at VA centers had a diagnosed mental health or substance use disorder; by 2014, that amount rose to 41 percent. This may be due to changes in demographics, an increased number of veterans seeking care, changes in how these conditions are diagnosed and treated, or other causes.

Rates of suicide among veterans who receive care through the VA who have a mental health condition or substance use disorder have declined since 2001. This suggests that treatment works.

Treatment for Mental Health and Substance Abuse Must Take Veteran Status into Account

War veteran talking about problems during therapy

The VA healthcare system offers several evidence-based approaches to supporting veterans who struggle with suicidal ideation and reducing their risks of attempting suicide. VA hospitals and healthcare facilities offer inpatient and residential psychiatric and substance abuse treatment programs; outpatient options, including group and individual counseling; medication; a special focus on PTSD and its impact on veterans; the Veterans Crisis Line; and local suicide prevention coordinators. For veterans who have suffered sexual abuse, VA facilities offer counseling and support for military sexual trauma experiences.

Because so many veterans live in rural areas and struggle to access care through VA facilities, the VA is expanding telemental health services, which can include counseling services over the phone and online. There are also several community-based counseling centers called Vet Centers, which provide many social and psychological services, including help readjusting to civilian life.

Counseling based in Cognitive Behavioral Therapy, medication for psychiatric conditions as needed, and mutual support groups are the foundation of treating depression, PTSD, substance abuse, and suicidal ideation. The VA supplies these services to veterans regardless of health insurance status. For veterans who may not be within easy reach of a VA hospital, many private facilities offer specialized treatment to veterans.