Abstract
As a healthcare provider, consider taking special notice of your patients who are veterans or active duty service members. You may be the only caregiver poised to recognize suicide risk in your patients who have served. Consider always asking patients, “Have you ever served in the military?” or “Have you ever worn the uniform?” (Some veterans do not know they qualify as a veteran and therefore it may not be effective to ask, “Are you a veteran?”)
A Principles
Health professionals in any setting may see veterans as patients and have a key role to play in detecting risk and preventing suicide in this important, higher risk population.
It is best to identify patients who are veterans by asking, “Have you ever served in the military?” or “Have you ever worn the uniform?”
Cultural and experiential factors such as experiences emphasizing self-sufficiency and strength can be barriers to overcome among military and veteran patients who are experiencing distress.
Help remind veterans and military personnel that strength includes getting help when you need it, and also remind them that we function better as a team than solo.
Veterans in the USA die by suicide at a 1.5 increased rate compared with the civilian age-matched cohort.
Veterans and active duty patients (and law enforcement as well) have a much higher incidence of firearm suicide than other populations. Therefore, lethal means counseling and including family members when possible is all the more critical.
Periods of transition during military life can increase suicide risk, and therefore are important times to increase support, access to care, and screening of risk.
B Introduction
As a healthcare provider, consider taking special notice of your patients who are veterans or active duty service members. You may be the only caregiver poised to recognize suicide risk in your patients who have served. Consider always asking patients, “Have you ever served in the military?” or “Have you ever worn the uniform?” (Some veterans do not know they qualify as a veteran and therefore it may not be effective to ask, “Are you a veteran?”)
Of the 17–20 US veterans who die by suicide each day, only 6 are receiving healthcare at the Veterans Health Administration (VHA). So it is up to other non-VHA clinical and community organizations to serve as a safety net that detects suicide risk and cares for veterans.
While active duty military service members and veterans are different groups, because of the overlap in experience between the groups they are being presented together in this section. Service members and veterans share similarities, notably a culture of self-reliance and potential fear of jeopardizing their career by seeking mental health services. Additionally, many veterans do not seek mental health treatment or are not forthcoming during treatment related to concerns that providers may take their firearms.
Military service experience can be viewed along a trajectory with transitions occurring at key points, including the transition when starting military training/service, pre- and post-deployment, and transitioning to civilian life into veteran status. Times of transition present challenges for all people, but particularly for those with risk factors. So as a healthcare provider to a military or veteran patient, it is important to make note of these life and career transitions and inquire about their mental health at these key times.
C Prevalence and Trends
Since the beginning of the wars in Afghanistan and Iraq (in 2001 and 2003 respectively), the suicide rate among US veterans has risen and is now higher than general population rates.
According to a 2019 VHA study based on 50 million veteran records from 1979 to 2017:1
◦ An average of 17 veterans die from suicide every day.
◦ In 2017, the suicide rate for veterans was 1.5 times the rate for non-veteran adults, after adjusting for population differences in age and sex.
– After adjusting for age, the rate of suicide among women veterans was 2.2 times the rate among non-veteran women.
– After adjusting for age, the rate of suicide among male veterans was 1.3 times higher than the rate among non-veteran males.
– Over 70% of male veteran suicides are by firearms and firearms accounted for 43% of female veteran suicide deaths.
– Veterans aged 18–34 had the highest suicide rate in 2017 of all age ranges (44.5 per 100,000).
– The absolute number of suicides was highest among veterans 55–74 years. This group accounted for 38% of all veteran suicides.
– Only 6 of the 17–20 veterans who take their lives each day are enrolled in the VHA. This means many at-risk veterans must be reached in healthcare and community settings outside the VHA.
