Suicidality Among Veterans Did Not Increase at the Beginning of the Pandemic

Update: As of January 17, 2023 all US veterans are eligible to receive emergency mental health care at no cost. This applies even if the individual isn’t enrolled in the VA system. The policy also includes the cost of ambulance rides, up to 30 days of inpatient care, and up to 90 days of outpatient care.

Veterans tend to be at high risk of mental health challenges and substance use issues. A study published in JAMA Psychiatry found that veterans did not report an increase in suicidality nearly 10 months into the pandemic.

This study measured changes in suicidal behavior from before the pandemic until about 10 months into the pandemic to identify possible risk factors.

Especially given how veterans may be impacted by the Taliban takeover of Afghanistan, mental health support should remain a priority for them.

Understanding the Research

This study was conducted with 3078 veterans, with an average age of 63.2 years, of whom, 91.6% were men, while 79.3% were non-Hispanic white, 10.3% were non-Hispanic Black, and 6% were Hispanic.

Suicidal ideation decreased from 10.6% in November 2019 to 7.8% in November 2020, while 2.6% developed new-onset suicidal ideation over the follow-up period. The strongest risk factors for developing suicidal ideation were low social support, previous suicide attempts, post traumatic stress disorder (PTSD), depression, recent alcohol use issues, COVID-19 infection, and decline in social relationships during the pandemic.

A limitation of this study is that suicidality is likely underestimated, as research demonstrates that participants hesitate to report stigmatizing behavior, as is the primarily older white male sample.

Resiliency in Crisis

Mental health professional, and US Coast Guard veteran, Zander Keig, LCSW, says, "It does not surprise me that veterans would be able to muster up resiliency during a crisis. That is what we are trained to do."

Given his personal experience with navigating military service, Keig explains that many veterans feel disconnected and estranged from a social network once discharged from the military. "That often leads to feeling useless and may then result in suicidal ideation," he says.

Keig illuminates, "It also does not surprise me that those veterans who contracted COVID-19 had an increase in suicidal ideation. Too many veterans are without social support and going through something like a serious illness alone can be devastating. Thankfully, it was only suicidal ideation, not actual suicide attempts that rose."

Supporting Veterans Saves Lives

Adult and geriatric psychiatrist and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center at Providence Saint John’s Health Center, David A. Merrill, MD, PhD, says, “Contrary to expectations, the rate of suicidal thoughts and suicide attempts by veterans decreased during the first year of the COVID-19 pandemic."

Merrill explains that more studies are needed to understand why the pandemic prompted some veterans to reach out and connect with others. "We do know that lack of social connection during the pandemic was the strongest risk for developing suicidal ideation," he says.

Merrill elucidates, "Supporting veterans saves lives. Veterans who reported a decrease in suicidal thoughts also reported an increase in perceived social support during the pandemic. Veterans who have had COVID-19 are at higher risk of suicide. Times of illness that affect the body and brain are particularly important times to support veterans."

In terms of mental health, Merrill explains that the traumas of war leave veterans vulnerable to PTSD, substance abuse, and depression. "All of these raise the risk of death by suicide," he says. 

Merrill explains, "The study found that veterans aged 65 and older had substantially lower rates of suicidal ideation both before and during the pandemic. In my work as a geriatric psychiatrist, I have seen many older adults who have handled the stress of the pandemic very well. Older adults have lived through so much, and can serve as role models to younger family members and loved ones of how to handle this period of high stress.”

Stigma Impacts Suicidality

Psychiatrist, and medical director of the Interventional Psychiatry and Clinical Research Institute with Mindpath Care Centers, Sandeep Vaishnavi, MD, PhD, says, "This study suggests that contrary to fears, the rates of suicidal thoughts actually went down during the pandemic in veterans." 

While this is heartening, Vaishnavi cautions that it is important to note that this study was based on self-report. "Since suicidal thoughts and suicide attempts can be stigmatized, the results may not be representative. It would be interesting to assess a hard endpoint such as documented suicide attempts. Also, of note, only 51.8% of the veterans asked to participate did so fully, so again, this may suggest the study may not be really representative of the population," he says.

Vaishnavi explains, "This study’s results are surprising based on our intuitive notions that during a stressful time like the pandemic, suicidality would increase.  However, that’s why it’s important to do the science, to do the studies.  Our intuitive notions do not always match what the data say.  Having said that, it is important to replicate this finding, particularly with a hard data endpoint such as documented suicide attempts."

During the pandemic, Vaishnavi believes that awareness has grown regarding the importance of behavioral health, which may improve willingness to access treatment. "This could include meditation and yoga practices. I have found that with my patients, there is increased interest in these practices to enhance self-care and wellness," he says.