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Suicidal thinking and US veterans

Military sucide

Nearly 14 percent of Veterans reported suicidal thinking at one or both phases of a two-year VA study.
Image credit goes to: Michael Escalante

Something very personal about me, the thought of suicide is never too far behind. It is to the point that I need to qualify it to my counselor when I am asked if I have thoughts of suicide, I always do. A new study shows that I am far from alone Nearly 14 percent of military veterans reported suicidal thinking at one or both phases of a two-year Veterans Affairs (VA) study.

More than 2,000 U.S. veterans were surveyed twice as part of the National Health and Resilience in Veterans Study, ask around we are a tough bunch and sometimes even tougher to know. The survey was first conducted in 2011 and again in 2013. Each time, the veterans were asked whether they had experienced suicidal thoughts in the past two weeks.

They also answered a host of other questions, which was important to determine the factors associated with suicidal thinking. About 86 percent of the veterans denied having any such thoughts, both times they were asked. I will be first to call BS, we are a tough bunch, but it is sometimes to the point that we refuse to admit we need help. If you need more proof than my word, look at veteran suicide statistics.

Like myself, about 5 percent had “chronic” suicidal thinking, this is defined a little differently than you might think though. These veterans reported suicidal thoughts in the past two weeks both times they were surveyed, two years apart. Nearly 4 percent had “remitted” suicidal thinking: They reported suicidal thoughts in the first questionnaire but not the second. Conversely, about 5 percent reported such thoughts only during the second survey.

Combined, 13.7 percent of the total sample reported suicidal thinking at either or both time points. While this is probably low, it at least, gives some sort of baseline and more importantly, a window into the lives of veterans in general.

It’s difficult to compare this prevalence rate to that of U.S. adults in general. Studies on suicide vary widely in their methods–for example, how questions are worded, and the time frames they cover and studies often focus on particular age brackets or other subgroups.

For a general reference point,  a study by the Centers for Disease Control and Prevention, published in 2011, in which 3.7 percent of U.S. adults reported having suicidal thoughts in the past year might be a good place to start. However, even by that yardstick, the rates in the new study are high.

“Our results … highlight the dynamic nature of [suicidal ideation],” write the researchers, “as evidenced by the meaningful proportion of U.S. veterans reporting changes in suicidal ideation over time.”

Thankfully, the study underscores the need for ongoing periodic monitoring–not just a one-time screening. Also, among those veterans who reported suicidal thinking only at wave 2, 65 percent had never engaged in any mental health treatment. While I can say this is not shocking, the researchers say this is another finding that points to the need for more outreach.

Not surprisingly, higher levels of psychiatric distress, physical health problems, and substance use history predicted chronic suicidal thinking and again this is a duh moment for anyone who is a veteran.

Social connectedness–widely seen as a major buffer against suicide risk–emerged in the study as a factor associated with the remission of suicidal thinking. By the same token, veterans who reported less social support at wave 1 were also more likely to report the onset of suicidal thinking at wave 2.

However, for many of the veterans reporting chronic suicidal thinking, social support did not appear to help that much. Speaking for myself, it is hard to connect to other people that have no idea what it is like to fight in a war, what are you going to talk about and how the hell do you explain your issues? How is social support going to help when no one can relate? The researchers say that for these veterans, addressing psychiatric and physical health, and substance use problems, may be more critical.

The study has several different limitations, as does any study really. Because so many people dropped from the first survey to the second, it would not be surprising to think that they were worse off and this has a likelihood of increasing the rate of suicidal thinking in the second survey.

Sources:
Smith, N., Mota, N., Tsai, J., Monteith, L., Harpaz-Rotem, I., Southwick, S., & Pietrzak, R. (2016). Nature and determinants of suicidal ideation among U.S. veterans: Results from the national health and resilience in veterans study Journal of Affective Disorders, 197, 66-73 DOI: 10.1016/j.jad.2016.02.069

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10 responses

  1. I can’t emphasize strongly enough that thinking non-vets can’t understand your struggle is an all-too-common myth that presents an avoidable obstacle to your healing process. Crime victims go through it. Abuse survivors too. Those who escape from human trafficking get it. People serving long sentences in prison get it. So do those who survive auto accidents in which loved ones die. It’s all PTSD, it has identical deleterious psychological and neurological effects (which will vary in degree per individual), and anyone experiencing sufficient stress from any source will get it.

    There is nothing unique about the stresses of combat compared to any other kind of life-threatening stress. Survivor’s guilt. Sleep difficulties. Hyper-vigilance. Substance abuse and self-medicating. Resistance to asking for help. And suicidal ideation. None of it is unique to vets, aside from the specific events that provide the cause.

    People aren’t machines. We all have limits, no matter how good the training is. No one can prepare for the thing that is too much, whatever it happens to be. The way back is the same for all, the same kind of therapy, the same lessons

    What you have in common with every other sufferer is that you went through enough to break you down and make you feel as if the only path to ending the pain was to self-terminate. But you have many more companions in the attempt to get well than 14%.

    April 5, 2016 at 3:08 pm

    • I can appreciate that, I’ve got a pretty good support these days. When I first got out and finally thought I could deal with going to school, well that was a different story. I was an injured war vet who was thrown into a group of teenagers who haven’t even left home. It was a struggle and honestly it sometimes still is, but I appreciate the insight, you are correct and I do tend to forget there are more people out there who understand than I give credit for. Thank you.

      April 6, 2016 at 11:41 am

      • It takes the time it takes. My own difficulties haven’t gone away, and maybe they never will, but over the past 25 years I’ve learned better coping mechanisms than drinking and rage. And how to celebrate each small progress. Best wishes!

        April 6, 2016 at 2:52 pm

  2. Well said. We need to continue to fight the stigmatization of mental health and provide the best access to services and quality care possible, especially to people like yourself. All the best with your recovery.

    April 5, 2016 at 3:52 pm

    • Thank you, I appreciate the support. I agree, all of us could use better care for mental health issues when we need them.

      April 6, 2016 at 11:42 am

  3. justa retiree

    Thank you for your very honest post, and thanks also to Invisible Mikey, for his thoughtful reply too. I would add that adults who are survivors of traumatic childhoods can suffer from PTSD all their lives, and your comments apply to us as well.

    Please stick with treatment and recovery, Dr. Jekyll. We so desperately need people who love science and are able to communicate clearly to non-scientists, as you do so well.

    April 5, 2016 at 4:37 pm

    • Thank you, you’re very kind. I plan on continuing treatment and you are correct, I can sometimes forget how many people suffer from PTSD. Thank you again 🙂

      April 6, 2016 at 11:44 am

      • justa retiree

        And I’m in no way trying to downplay your experience. Just wanted to say you’re not alone and that many people understand, of course not completely but each in our own way.

        April 6, 2016 at 2:51 pm

  4. I agree whole heartedly with calling BS on the 86% saying they never had thoughts of suicide. I would bet almost all of us that went to war have lied when asked that question. I know I did for a while.

    April 5, 2016 at 4:47 pm

    • Yeah I was the same way for the first 2-3 years after I was discharged. It wasn’t until I practically hit bottom that I thought that maybe trying to suck it up and deal with it wasn’t going to cut it.

      April 6, 2016 at 11:47 am

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