Suicide is a major public health challenge that disproportionately affects veterans—both men and women—in the U.S. In 2020, the rate among this group was 57% higher than their non-veteran counterparts, according to the 2022 National Veteran Suicide Prevention Annual Report by the U.S. Department of Veterans Affairs (VA). The report, published in September, also discusses the federal government’s comprehensive public health strategy to improve suicide prevention interventions for veterans. Included in these efforts is the practice of universal suicide risk screening to help stop these preventable deaths.
Research suggests that a multitude of factors contribute to the risk of suicide among veterans. Military service can lead to post-traumatic stress disorder, depression, substance use disorders, and chronic pain and other serious health conditions. To make matters worse, too often veterans experience systemic barriers to accessing critical health care. The VA states that preventing suicides is its top clinical priority, and has made resources available, including evidence-based therapies, mobile apps to promote mental health, and special training for anyone who encounters a veteran in crisis. Yet administrative and bureaucratic challenges, including availability of providers, long wait times, and financial qualifications, are ongoing obstacles in some places, and can discourage veterans from getting the care they need.
However, many veterans who die by suicide utilized health services, including through the Veterans Health Administration (VHA), in the weeks or months leading up to their deaths. The VA reported that in 2020, 40% of veterans who died by suicide had a VHA encounter in the year of their death or year prior. Previous research found that 56% of male VHA patients with substance use disorders who died by suicide had a VHA encounter in the month before death, and 25% in the week prior. These health care visits are critical opportunities to identify patients experiencing suicidality—which includes suicidal thoughts, plans, deliberate self-harm, and suicide attempts—and connect them to evidence-based treatment.
In 2018, the VA published a 10-year broad public health strategy on preventing suicide among veterans. This comprehensive, interagency approach includes implementing effective treatment and support services for veterans already identified as high risk. It also emphasizes the importance of strengthening clinical and community suicide prevention initiatives, including universal screening.
This screening practice means that all patients are briefly assessed for risk of suicide upon intake at a health care setting regardless of whether they are exhibiting signs of suicidality. Research shows that universal screening is effective at identifying a greater number of people experiencing suicide risk compared with assessing only those seeking behavioral or mental health care. The results of a recent study looking at VHA data suggests that screening all veterans in these settings, not only veterans seeking mental health treatment, will help ensure individuals experiencing suicide risk receive appropriate care.
Patient data from hospitals and health systems outside of the VA show similar results. When looking at the general population, research reveals that about half of people who die by suicide see a health care professional in the month before their deaths. And more than half of the people who die by suicide do not have a known mental health condition. But including universal screening as part of comprehensive suicide care can help prevent suicides. A study of eight emergency departments showed that universal suicide risk screening helped identify twice as many people who were at risk for suicide compared with screening only patients presenting with psychiatric symptoms. Researchers have also found that universal screening followed by evidence-based interventions reduced total suicide attempts by 30% that year.
Despite some concerns from health care providers, talking about suicide does not increase risk of suicidal thoughts or behavior. Evidence indicates that suicide risk screening is not associated with increased suicidality; on the contrary, directly communicating with patients about suicide helps identify at-risk individuals and connect them to treatment. And incorporating universal screening is even feasible without disrupting workflow, with an initial screening taking less than a minute and covered by public and private insurance. All patients, veteran and civilian, can and should be asked a few simple questions to determine suicide risk so they have an opportunity to receive care.
Although there is no simple solution to the devastating problem of suicide among veterans, there are evidence-based preventive measures and interventions that can help save veterans’ lives. The place to start is expanded and improved suicide screening to ensure veterans receive the critical treatment and support services they need.
Allison Corr works on The Pew Charitable Trusts’ suicide risk reduction project.