VA’s Annual Report on Suicide: Reasons for Despair—and Hope

When COVID-19 hit, the number of suicides among veterans had been going down. Before 2021, veteran suicide declined 2 years in a row—from 6718 in 2018 to 6278 in 2020. But in 2021, the trend began to reverse: 6392 veterans died by suicide, according to the US Department of Veterans Affairs (VA) recently released National Veteran Suicide Prevention Annual Report, which includes the first full year of information since March 2020.

The pandemic took a toll in uncountable ways: increasing social and financial insecurity, anxiety, depression, and barriers to health care—all factors associated with a higher risk of suicide. Nonveteran suicides also increased, to 40,020 deaths in 2021, 2000 more than in 2020. But the age- and sex-adjusted suicide rate among veterans increased by 11.6%, compared with an increase of 4.5% among nonveteran adults.

In 2021, the unadjusted suicide rate was highest among American Indian or Alaska Natives (46.3 per 100,000), followed by 36.3 per 100,000 for White veterans; 31.6 per 100,000 for Asian, Native Hawaiian or Pacific Islander veterans; 19.7 per 100,000 for veterans with Hispanic ethnicity; 17.4 per 100,000 for Black or African American veterans; and 6.7 per 100,000 for veterans of multiple races.

The report demonstrates a deep dive into the data but the findings on risk factors may come as no surprise. A documented factor in the rise in suicide among veterans was distress, which increased from fall 2019 to fall and winter 2020, with evidence of the highest increases in distress among veterans aged 18 to 44 years and among women veterans. The rise in distress was associated with increasing socioeconomic concerns, greater problematic alcohol use, and less community integration. Moreover, during the pandemic, veterans were found to experience more mental health concerns than nonveterans.

A review of 23 studies found a greater prevalence of alcohol use, anxiety, depression, posttraumatic stress disorder, stress, loneliness, and suicidal ideation. Key risk factors included pandemic-related stress, family relationship strain, lack of social support, financial concerns, and preexisting mental health disorders.

VA Behavioral Health Autopsy Program data indicated that the most frequently identified risk factors for suicide deaths in 2019 to 2021 were pain (55.9%), sleep problems (51.7%), increased health problems (40.7%), relationship problems (33.7%), recent declines in physical ability (33.0%), hopelessness (30.6%) and unsecured firearms in the home (28.8%).

Meanwhile, more people were buying guns: A study published in the Annals of Internal Medicine found that, as of April 2021, approximately 10% of gun owners in the US had become new gun owners over the previous 28 months. Firearm availability is known to increase the risk of suicide and the risk of dying during a suicide attempt. According to 2021 VA data, nearly 7 of every 10 veteran deaths by suicide are the result of firearm injuries.

Among US adults who died from suicide in 2021, firearms were more commonly involved among veteran deaths (72.2%) than among nonveteran deaths (52.2%). In each year studied, firearm suicide mortality rates were greater for men than for women; however, the firearm suicide rate among veteran women was 281.1% higher than that of nonveteran women, while the firearm suicide rate among veteran men was 62.4% higher than for nonveteran men.

But there were some bright spots. “Hope is essential to life,” the report says, “and hope serves an important role within suicide prevention efforts.” It points to areas where things improved, even amid the pandemic. Suicide rates fell by 8.1% for veteran men aged 75 years and older. Among recent VA users between ages 55 and 74 years, the suicide rate fell by 2.2% overall (-0.6% for men, -24.9% for women). Among male recent VA users, suicide rates fell by 1.9% for those aged 18 to 34 years. From 2001 to 2021, the suicide rate among recent VA users with mental health or substance use disorder diagnoses fell from 77.8 per 100,000 to 58.2 per 100,000.

Nonetheless, the data show veterans “remain at elevated risk for suicide.” “We will do everything in our power to learn from this report and use its findings to help us save lives,” said VA Under Secretary for Health Shereef Elnahal, MD. “It will take all of us—working together—to end veteran suicide, and we will not rest until that goal becomes a reality.”

“Suicide is a complex problem,” Dr. Carolyn Clancy, Executive in Charge, Office of the Under Secretary for Health, writes in the VA publication National Strategy for Preventing Veteran Suicide, 2018–2028. “[I]t requires coordinated, evidence-based solutions that reach beyond the traditional medical model of prevention.” She notes that the VA has “embraced a comprehensive public health approach to reduce veteran suicide rates, one that looks beyond the individual to involve peers, family members, and the community.”

“Yet we know we cannot do it alone, as roughly half of all veterans in the US do not receive services or benefits from VA. This means we must collaborate with partners and communities nationwide to use the best available information and practices to support all veterans, whether or not they’re engaging with VA.”

The VA calls ending veteran suicide its top clinical priority and supports the Biden Administration’s goal of reducing the annual suicide rate in the US by 20% by 2025. Since 2021, the VA has bolstered and broadened resources for at-risk veterans, such as no-cost health care at VA or non-VA facilities for those in crisis; the 988 (then press 1) Veterans Crisis Line; partnerships with community-based suicide prevention organizations; and expanded firearm suicide prevention efforts.

The VA says these efforts, plus a national veteran suicide prevention awareness campaign, have led to more than 33,000 veterans getting free emergency health care, a 12.1% increase in use of the Veterans Crisis Line, and more than 3.5 million visits to the VA’s support website. Moving forward, the VA says, it will continue to work “urgently” alongside the Biden-Harris Administration to end veteran suicide through a public health approach that combines both community-based and clinically based strategies to save lives.

“There is nothing more important to VA than preventing veteran suicide —nothing,” said Secretary of VA Denis McDonough. “One veteran suicide will always be too many, and we at VA will use every tool to our disposal to prevent these tragedies and save veterans’ lives.”

If you or someone you know is having thoughts of suicide, call or text 988 to reach the National Suicide Prevention Lifeline or contact the Veterans Crisis Line: www.veteranscrisisline.net.

Related resources:

- The National Suicide Prevention Lifeline is a hotline for individuals in crisis or for those looking to help someone else. To speak with a certified listener, call 1-800-273-8255.

- Crisis Text Line is a texting service for emotional crisis support. To speak with a trained listener, text HELLO to 741741. It is free, available 24/7, and confidential.

- American Foundation for Suicide Prevention. https://afsp.org/

When COVID-19 hit, the number of suicides among veterans had been going down. Before 2021, veteran suicide declined 2 years in a row—from 6718 in 2018 to 6278 in 2020. But in 2021, the trend began to reverse: 6392 veterans died by suicide, according to the US Department of Veterans Affairs (VA) recently released National Veteran Suicide Prevention Annual Report, which includes the first full year of information since March 2020.

The pandemic took a toll in uncountable ways: increasing social and financial insecurity, anxiety, depression, and barriers to health care—all factors associated with a higher risk of suicide. Nonveteran suicides also increased, to 40,020 deaths in 2021, 2000 more than in 2020. But the age- and sex-adjusted suicide rate among veterans increased by 11.6%, compared with an increase of 4.5% among nonveteran adults.

In 2021, the unadjusted suicide rate was highest among American Indian or Alaska Natives (46.3 per 100,000), followed by 36.3 per 100,000 for White veterans; 31.6 per 100,000 for Asian, Native Hawaiian or Pacific Islander veterans; 19.7 per 100,000 for veterans with Hispanic ethnicity; 17.4 per 100,000 for Black or African American veterans; and 6.7 per 100,000 for veterans of multiple races.

The report demonstrates a deep dive into the data but the findings on risk factors may come as no surprise. A documented factor in the rise in suicide among veterans was distress, which increased from fall 2019 to fall and winter 2020, with evidence of the highest increases in distress among veterans aged 18 to 44 years and among women veterans. The rise in distress was associated with increasing socioeconomic concerns, greater problematic alcohol use, and less community integration. Moreover, during the pandemic, veterans were found to experience more mental health concerns than nonveterans.

A review of 23 studies found a greater prevalence of alcohol use, anxiety, depression, posttraumatic stress disorder, stress, loneliness, and suicidal ideation. Key risk factors included pandemic-related stress, family relationship strain, lack of social support, financial concerns, and preexisting mental health disorders.

VA Behavioral Health Autopsy Program data indicated that the most frequently identified risk factors for suicide deaths in 2019 to 2021 were pain (55.9%), sleep problems (51.7%), increased health problems (40.7%), relationship problems (33.7%), recent declines in physical ability (33.0%), hopelessness (30.6%) and unsecured firearms in the home (28.8%).

Meanwhile, more people were buying guns: A study published in the Annals of Internal Medicine found that, as of April 2021, approximately 10% of gun owners in the US had become new gun owners over the previous 28 months. Firearm availability is known to increase the risk of suicide and the risk of dying during a suicide attempt. According to 2021 VA data, nearly 7 of every 10 veteran deaths by suicide are the result of firearm injuries.

Among US adults who died from suicide in 2021, firearms were more commonly involved among veteran deaths (72.2%) than among nonveteran deaths (52.2%). In each year studied, firearm suicide mortality rates were greater for men than for women; however, the firearm suicide rate among veteran women was 281.1% higher than that of nonveteran women, while the firearm suicide rate among veteran men was 62.4% higher than for nonveteran men.

But there were some bright spots. “Hope is essential to life,” the report says, “and hope serves an important role within suicide prevention efforts.” It points to areas where things improved, even amid the pandemic. Suicide rates fell by 8.1% for veteran men aged 75 years and older. Among recent VA users between ages 55 and 74 years, the suicide rate fell by 2.2% overall (-0.6% for men, -24.9% for women). Among male recent VA users, suicide rates fell by 1.9% for those aged 18 to 34 years. From 2001 to 2021, the suicide rate among recent VA users with mental health or substance use disorder diagnoses fell from 77.8 per 100,000 to 58.2 per 100,000.

Nonetheless, the data show veterans “remain at elevated risk for suicide.” “We will do everything in our power to learn from this report and use its findings to help us save lives,” said VA Under Secretary for Health Shereef Elnahal, MD. “It will take all of us—working together—to end veteran suicide, and we will not rest until that goal becomes a reality.”

“Suicide is a complex problem,” Dr. Carolyn Clancy, Executive in Charge, Office of the Under Secretary for Health, writes in the VA publication National Strategy for Preventing Veteran Suicide, 2018–2028. “[I]t requires coordinated, evidence-based solutions that reach beyond the traditional medical model of prevention.” She notes that the VA has “embraced a comprehensive public health approach to reduce veteran suicide rates, one that looks beyond the individual to involve peers, family members, and the community.”

“Yet we know we cannot do it alone, as roughly half of all veterans in the US do not receive services or benefits from VA. This means we must collaborate with partners and communities nationwide to use the best available information and practices to support all veterans, whether or not they’re engaging with VA.”

The VA calls ending veteran suicide its top clinical priority and supports the Biden Administration’s goal of reducing the annual suicide rate in the US by 20% by 2025. Since 2021, the VA has bolstered and broadened resources for at-risk veterans, such as no-cost health care at VA or non-VA facilities for those in crisis; the 988 (then press 1) Veterans Crisis Line; partnerships with community-based suicide prevention organizations; and expanded firearm suicide prevention efforts.

The VA says these efforts, plus a national veteran suicide prevention awareness campaign, have led to more than 33,000 veterans getting free emergency health care, a 12.1% increase in use of the Veterans Crisis Line, and more than 3.5 million visits to the VA’s support website. Moving forward, the VA says, it will continue to work “urgently” alongside the Biden-Harris Administration to end veteran suicide through a public health approach that combines both community-based and clinically based strategies to save lives.

“There is nothing more important to VA than preventing veteran suicide —nothing,” said Secretary of VA Denis McDonough. “One veteran suicide will always be too many, and we at VA will use every tool to our disposal to prevent these tragedies and save veterans’ lives.”

If you or someone you know is having thoughts of suicide, call or text 988 to reach the National Suicide Prevention Lifeline or contact the Veterans Crisis Line: www.veteranscrisisline.net.

Related resources:

- The National Suicide Prevention Lifeline is a hotline for individuals in crisis or for those looking to help someone else. To speak with a certified listener, call 1-800-273-8255.

- Crisis Text Line is a texting service for emotional crisis support. To speak with a trained listener, text HELLO to 741741. It is free, available 24/7, and confidential.

- American Foundation for Suicide Prevention. https://afsp.org/

When COVID-19 hit, the number of suicides among veterans had been going down. Before 2021, veteran suicide declined 2 years in a row—from 6718 in 2018 to 6278 in 2020. But in 2021, the trend began to reverse: 6392 veterans died by suicide, according to the US Department of Veterans Affairs (VA) recently released National Veteran Suicide Prevention Annual Report, which includes the first full year of information since March 2020.

The pandemic took a toll in uncountable ways: increasing social and financial insecurity, anxiety, depression, and barriers to health care—all factors associated with a higher risk of suicide. Nonveteran suicides also increased, to 40,020 deaths in 2021, 2000 more than in 2020. But the age- and sex-adjusted suicide rate among veterans increased by 11.6%, compared with an increase of 4.5% among nonveteran adults.

In 2021, the unadjusted suicide rate was highest among American Indian or Alaska Natives (46.3 per 100,000), followed by 36.3 per 100,000 for White veterans; 31.6 per 100,000 for Asian, Native Hawaiian or Pacific Islander veterans; 19.7 per 100,000 for veterans with Hispanic ethnicity; 17.4 per 100,000 for Black or African American veterans; and 6.7 per 100,000 for veterans of multiple races.

The report demonstrates a deep dive into the data but the findings on risk factors may come as no surprise. A documented factor in the rise in suicide among veterans was distress, which increased from fall 2019 to fall and winter 2020, with evidence of the highest increases in distress among veterans aged 18 to 44 years and among women veterans. The rise in distress was associated with increasing socioeconomic concerns, greater problematic alcohol use, and less community integration. Moreover, during the pandemic, veterans were found to experience more mental health concerns than nonveterans.

A review of 23 studies found a greater prevalence of alcohol use, anxiety, depression, posttraumatic stress disorder, stress, loneliness, and suicidal ideation. Key risk factors included pandemic-related stress, family relationship strain, lack of social support, financial concerns, and preexisting mental health disorders.

VA Behavioral Health Autopsy Program data indicated that the most frequently identified risk factors for suicide deaths in 2019 to 2021 were pain (55.9%), sleep problems (51.7%), increased health problems (40.7%), relationship problems (33.7%), recent declines in physical ability (33.0%), hopelessness (30.6%) and unsecured firearms in the home (28.8%).

Meanwhile, more people were buying guns: A study published in the Annals of Internal Medicine found that, as of April 2021, approximately 10% of gun owners in the US had become new gun owners over the previous 28 months. Firearm availability is known to increase the risk of suicide and the risk of dying during a suicide attempt. According to 2021 VA data, nearly 7 of every 10 veteran deaths by suicide are the result of firearm injuries.

Among US adults who died from suicide in 2021, firearms were more commonly involved among veteran deaths (72.2%) than among nonveteran deaths (52.2%). In each year studied, firearm suicide mortality rates were greater for men than for women; however, the firearm suicide rate among veteran women was 281.1% higher than that of nonveteran women, while the firearm suicide rate among veteran men was 62.4% higher than for nonveteran men.

But there were some bright spots. “Hope is essential to life,” the report says, “and hope serves an important role within suicide prevention efforts.” It points to areas where things improved, even amid the pandemic. Suicide rates fell by 8.1% for veteran men aged 75 years and older. Among recent VA users between ages 55 and 74 years, the suicide rate fell by 2.2% overall (-0.6% for men, -24.9% for women). Among male recent VA users, suicide rates fell by 1.9% for those aged 18 to 34 years. From 2001 to 2021, the suicide rate among recent VA users with mental health or substance use disorder diagnoses fell from 77.8 per 100,000 to 58.2 per 100,000.

Nonetheless, the data show veterans “remain at elevated risk for suicide.” “We will do everything in our power to learn from this report and use its findings to help us save lives,” said VA Under Secretary for Health Shereef Elnahal, MD. “It will take all of us—working together—to end veteran suicide, and we will not rest until that goal becomes a reality.”

“Suicide is a complex problem,” Dr. Carolyn Clancy, Executive in Charge, Office of the Under Secretary for Health, writes in the VA publication National Strategy for Preventing Veteran Suicide, 2018–2028. “[I]t requires coordinated, evidence-based solutions that reach beyond the traditional medical model of prevention.” She notes that the VA has “embraced a comprehensive public health approach to reduce veteran suicide rates, one that looks beyond the individual to involve peers, family members, and the community.”

“Yet we know we cannot do it alone, as roughly half of all veterans in the US do not receive services or benefits from VA. This means we must collaborate with partners and communities nationwide to use the best available information and practices to support all veterans, whether or not they’re engaging with VA.”

The VA calls ending veteran suicide its top clinical priority and supports the Biden Administration’s goal of reducing the annual suicide rate in the US by 20% by 2025. Since 2021, the VA has bolstered and broadened resources for at-risk veterans, such as no-cost health care at VA or non-VA facilities for those in crisis; the 988 (then press 1) Veterans Crisis Line; partnerships with community-based suicide prevention organizations; and expanded firearm suicide prevention efforts.

The VA says these efforts, plus a national veteran suicide prevention awareness campaign, have led to more than 33,000 veterans getting free emergency health care, a 12.1% increase in use of the Veterans Crisis Line, and more than 3.5 million visits to the VA’s support website. Moving forward, the VA says, it will continue to work “urgently” alongside the Biden-Harris Administration to end veteran suicide through a public health approach that combines both community-based and clinically based strategies to save lives.

“There is nothing more important to VA than preventing veteran suicide —nothing,” said Secretary of VA Denis McDonough. “One veteran suicide will always be too many, and we at VA will use every tool to our disposal to prevent these tragedies and save veterans’ lives.”

If you or someone you know is having thoughts of suicide, call or text 988 to reach the National Suicide Prevention Lifeline or contact the Veterans Crisis Line: www.veteranscrisisline.net.

Related resources:

- The National Suicide Prevention Lifeline is a hotline for individuals in crisis or for those looking to help someone else. To speak with a certified listener, call 1-800-273-8255.

- Crisis Text Line is a texting service for emotional crisis support. To speak with a trained listener, text HELLO to 741741. It is free, available 24/7, and confidential.

- American Foundation for Suicide Prevention. https://afsp.org/