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VA research on

Suicide Prevention


Introduction

According to the Centers for Disease Control and Prevention, there were 48,344 suicides in 2018 in the United States, or more than 132 suicides each day. In 2019, VA’s National Veteran Suicide Prevention Annual Report estimated that 6,139 U.S. Veterans died by suicide in 2017, an average of 16.8 per day. In that year, the suicide rate for Veterans was 1.5 times the rate for non-Veteran adults, after adjusting for population differences in age and sex.

Veterans can be at risk for suicide for a variety of reasons. Some are coping with the effects of aging, homelessness, or unaddressed chronic health conditions stemming from military service. Many Veterans have underlying mental health conditions or substance use disorders, in some cases aggravated by their military service, which increases their risk of suicide. Many recently discharged servicemembers have difficulty with personal relationships or their transition back to civilian life.

In June 2019, VA and the White House announced the creation of a task force to develop a national roadmap to prevent suicide among Veterans. The President’s Roadmap to Empower Veterans and End the National Tragedy of Suicide (PREVENTS) task force will include a community integration and collaboration proposal, a national research strategy, and an implementation strategy. It followed a March 2019 executive order, signed by President Trump, titled “National Roadmap to Empower Veterans and End Suicide.” 

As part of VA's efforts to address this problem, the department has established a toll-free, confidential Veterans Crisis Line at 1-800-273-8255 (1-800-273-TALK), press 1. The hotline is staffed by mental health professionals 24 hours a day, seven days a week. It has received more than 4.4 million calls, and has initiated the dispatch of emergency services to callers in imminent crisis more than 138,000 times. VA also offers a texting service at #838255.

Veterans and their families can also chat online with trained counselors at www.VeteransCrisisLine.net. Since its inception, the Veterans Crisis line has answered nearly 511,000 chat requests and more than 150,000 texts. Registration with VA or enrollment in VA health care is not necessary. VA also has full-time suicide prevention coordinators at each of its 170 medical centers.

In 2018, VA partnered with the Department of Defense’s Telehealth and Technology Center to develop and test a smartphone app called the Virtual Hope Box. Veterans set up the app with photos of friends and family, sound bites and videos of loved ones and special moments, music, relaxation exercises, games, help line numbers, and reminders of reasons for living. The app supports a mix of pre-loaded and user-created content and can be customized according to the Veterans’ specific needs.

VA's Center of Excellence for Suicide Prevention, located at the Canandaigua VA Medical Center in New York, has a mission to reduce occurrences of suicide, primarily by studying and applying public health approaches to suicide prevention.

VA's Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) studies suicide with the goal of reducing suicide in the Veteran population.

Researchers at the MIRECC in Denver work to provide useful information about suicide prevention in ways that are accessible to Veterans and the community at large. They also look at strategies to translate research-informed practices into everyday care.

The MIRECC's website offers, among other products, a suicide attempt survivor family resource guide and guides for talking to children about suicide attempts in the family. Products are available in English and Spanish.

VA’s Suicide Prevention Research Impact NeTwork (SPRINT) is a research consortium that aims to accelerate suicide prevention research, leading to improvements in care that will ultimately result in reduction in suicide behaviors among Veterans. The network seeks to identify and prioritize gaps in suicide prevention health services research and will establish a focused health services research agenda for SPRINT members.

VA is also part of the Military Suicide Research Consortium, a partnership with DOD that manages research to increase knowledge on topics such as risk assessment, treatment, and prevention as they pertain to suicidal behavior in the military and among Veterans.

In 2017, VA and the U.S. Department of Energy (DOE) announced a partnership focused on the secure analysis of large amounts of health and genomic data to help advance heath care for Veterans and others in areas such as suicide prevention. The partnership is based within DOE's National Laboratory System, one of the world's top supercomputing resources.

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Selected Major Accomplishments in VA Research

  • 2007: Established a Center of Excellence for Suicide Prevention in Canandaigua, New York
  • 2012:
    • Completed a report providing data on suicides and attempted suicides among Veterans
    • Found that the experience of killing in war was strongly associated with thoughts of suicide
  • 2016:
    • Determined that Veterans receiving high doses of opioid painkillers were more than twice as likely to die by suicide than those receiving low doses
    • Announced a series of actions to reduce Veteran suicide, including using data on suicide attempts and overdoses to guide prevention strategies
    • Launched the REACH VET program, which analyzes existing data to identify Veterans at a statistically elevated risk for suicide and allows VA to provide them with pre-emptive care and support
  • 2018: Demonstrated the value of a simple emergency room intervention to help reduce suicide risk
  • 2019:
    • Found that the long-term use of benzodiazepines in patients with chronic obstructive pulmonary disease (COPD) and posttraumatic stress disorder (PTSD) may lead to increased suicide risk
    • Along with the White House, established the PREVENTS Task Force to develop a national research strategy to prevent suicide among Veterans
    • Funded the SPRINT Consortium of Research to accelerate suicide prevention research

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New, Ongoing, and Published Research

Preventing suicide is one of VA’s key priorities and is also a public health priority for the entire United States. Because significant VA resources are devoted to preventing suicide among Veterans, Veterans treated in VA are significantly less likely to complete the act of suicide than Veterans outside the VA health care system. VA’s National Strategy for Veteran Suicide 2018-2024 is the department’s comprehensive strategy for preventing suicides among Veterans.

VA researchers are working to identify factors that increase the risk of suicide among Veterans and planning studies to prevent suicide by directly responding to a Veteran’s individual risk profile. They are building new tools to help manage risk factors, identify more effective prevention strategies, and better ensure the successful transition of Veterans into the VA health care system. Many investigators focus on the transition from active-duty military service to civilian life, a period of particular suicide risk.

Other researchers are developing national data systems to capture and manage information on Veterans that relates to suicide, attempted suicide, and suicide reattempts among Veterans. These systems will help investigators determine risk and protective factors for suicidal behavior.

For more information on Suicide Prevention, visit our DepressionMental HealthPTSDSubstance Use DisordersTraumatic Brain Injury, and Women Health topic pages.

If you are interested in learning about joining a VA-sponsored clinical trial, visit our research study information page.

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➤ Reporting on Veteran suicide

Awareness of suicide prevention programs among U.S. military Veterans—VA offers a number of suicide prevention programs for Veterans, some of which are described above. Researchers with the VA Connecticut Healthcare System and elsewhere conducted a survey, published in 2020, to assess Veterans’ awareness of and participation in VA’s suicide prevention programs.

The team surveyed a nationally representative sample of 1,002 Veterans online. The majority reported knowing about VA Vet Centers, the Veterans Crisis Line, and VA’s Center for Suicide Prevention. However, only 5% had attended a local community event related to Veteran suicide and only 2% had used VA’s Virtual Hope Box.

A history of suicidal thoughts or attempts was not associated with awareness of suicide prevention programs. More targeted outreach, the team believes, may be needed for Veterans at risk for suicide who are unaware of what VA offers in this area.

Comprehensive data on Veteran suicide—In 2013, VA released its first comprehensive report on Veterans who die by suicide. Before this report was issued, data on Veterans who died by suicide was only available for those who had sought VA health care services.

The report indicated that the percentage of Veterans who die by suicide decreased slightly from 1999 through 2009, while the estimated total number of Veterans who died by suicide increased. Investigators learned that a majority of Veteran suicides are among those aged 50 years and older, and that male Veterans who die by suicide are older than non-Veteran males who die in that way. This was not true of women, however. For women, the age distribution was similar between Veterans and non-Veterans.

An updated report issued in 2019 represents the most comprehensive analysis to date of Veteran suicide rates. It includes data from 1979 to 2017, from every state in the U.S. Key results from that report include:

  • The number of Veteran suicides exceeded 6,000 each year from 2008 to 2017.
  • Among U.S. adults, the average number of suicides per day rose from 86.6 in 2005 to 124.4 in 2017. These numbers included 15.9 Veteran suicides per day in 2005 and 16.8 in 2017.
  • 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.
  • Firearms were the method of suicide in 70.7% of male Veteran suicide deaths and 43.2% of female Veteran suicide deaths in 2017.
  • In addition to Veteran suicides, there were 919 suicides among never federally activated former National Guard and Reserve members in 2017, an average of 2.5 suicide deaths per day.

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➤ Risk factors for suicide among Veterans

Sexual dysfunction linked to suicidal thoughts—Sexual dysfunction is common in people with posttraumatic stress disorder (PTSD). In a 2020 study led by researchers with the San Diego VA Health Care System, a team assessed 138 Veterans and their partners before they began couples-based PTSD treatment. The assessment showed that, in male Veterans, decreased sexual pleasure and decreased frequency of sexual intercourse were linked with more recent suicidal thoughts.

In female Veterans, increased sexual frequency was marginally linked with increased suicidal thoughts. The researchers stressed the importance of assessing sexual function as a risk factor for suicide, and suggested therapists should consider the possibility that sexual functioning may be protective or predictive of suicidality depending on the person being treated and the context of the treatment.

Post-TBI symptoms linked to suicide attempts—Having traumatic brain injury (TBI) symptoms before deployment is associated with an increased risk of suicide attempt following deployment, according to a study published in 2020 that included a VA San Diego Healthcare System researcher.

The research team studied data on 7,677 soldiers deployed to Afghanistan in 2012. Of these, 103 attempted suicide. The team found that soldiers who had had post-concussive or TBI symptoms prior to deployment had a higher risk of suicide attempt than those without TBI symptoms. Therefore, detecting TBI symptoms could help target Veterans who would benefit from suicide prevention programs.

In a 2019 study of the effects of TBI on suicide attempts, a team of researchers funded by VA’s Mid-Atlantic MIRECC found that post-9/11 Veterans with a history of repeated TBIs were about twice as likely to report suicidal thoughts over the week before being surveyed, compared with Veterans who had had one TBI or none at all.

The findings were developed from interviews with more than 800 Veterans who had combat roles in Iraq and Afghanistan. About half of the interviewees reported at least one TBI. Nearly 20% of those with a history of multiple TBIs said they had recent suicidal ideation—thoughts of suicide—compared with 11% of Veterans with one TBI and 9% with no history of a TBI.

PTSD, however, was not consistently associated with suicidal ideation in Veterans with TBI.

Social determinants of health and suicide—Social determinants of health are economic and social conditions that can influence an individual's or group's health status. In a 2019 study, researchers at the VA Pittsburgh Healthcare System’s Center for Health Equity Research and Promotion used VA electronic health data to learn that seven adverse social determinants of health were strongly associated with thoughts of suicide and suicide attempts in Veterans, even after adjusting for mental health diagnoses.

The seven adverse social determinants of health were violence, housing instability, financial or employment problems, legal problems, familial or social problems, lack of access to health care and transportation, and nonspecific psychosocial needs. The team concluded that integrating social determinants of health into the electronic health record, using ICD-10 codes, could improve suicide prevention efforts.

Suicide risk common in patients with anxiety—In a 2019 study, a team of researchers with the Syracuse VA Medical Center found that 40% of surveyed Veterans with anxiety had at least one risk factor for suicide. The team surveyed 182 primary care patients who had anxiety symptoms but were not in psychotherapy specialty care.

The researchers found that suicide risk was more common in Veterans who also screened positive for depression than in those who had anxiety alone. The severity of anxiety symptoms did not affect Veterans’ suicide risk. The researchers believe primary care providers should assess suicide risk in patients with anxiety even when those patients are not seeking mental health treatment or when their anxiety symptoms do not rise to the level of a disorder.

Two genes may be linked to suicide attempts—Researchers with the Durham VA Medical Center and Duke University conducted a genome-wide association study, published in 2018, in which they examined the genomes of a large sample of Veterans to look for genetic variations that could be associated with a history of suicidal behavior. (A genome is the complete set of genetic information in a person or organism.)

The team found an association between suicide attempts and a gene called KCNMB2, which plays an important role in neuronal excitability. They also found evidence that may link another gene, ABI3BP, to both suicide attempts and suicidal thoughts. The researchers cautioned that additional work to replicate and extend their findings is needed.

Possible link between low cholesterol and suicide—Researchers at the Coatesville VA Medical Center in Pennsylvania found that lower cholesterol levels may be a biomarker for suicidal behavior. The 2017 study results indicated that Veterans with total cholesterol levels below 168 mg/dL appeared to be at higher risk of suicide than those with higher cholesterol levels. The researchers examined the medical records of 128 Veterans who received care at the Coatesville VA and who were included in a suicide prevention database.

Veterans in the study who experienced suicidal thoughts or attempts had cholesterol levels that were significantly lower than those who did not. Further analysis found that Veterans with suicidal behaviors were younger; leaner; and had more anxiety, more sleep problems, and higher education than those who were being seen for a health issue unrelated to suicide. The researchers cautioned against making a definitive link between low cholesterol and suicide risk.

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➤ Predictors of suicidal behavior

Suicidal thoughts and behaviors, including suicide attempts and death by suicide, are commonly found at higher rates among people with psychiatric disorders. VA researchers have studied warning signs in hopes of being able to prevent suicide in Veterans and others.

Benzodiazepines may increase suicide risk—Benzodiazepines are sedative drugs commonly prescribed for conditions such as insomnia, anxiety, and dementia. They are also prescribed to people with PTSD and are often given to patients with chronic obstructive pulmonary disorder (COPD) to treat symptoms.

In a 2019 study, researchers from VA Puget Sound Health Care System in Seattle and the University of Washington found long-term use of benzodiazepines in COPD patients who also had PTSD more than doubled their risk of suicide. The researchers looked at the medical records of 44,555 Veterans who received VA care between 2010 and 2012. Of these, 23.6% received benzodiazepines for 90 days or longer. The researchers found that these patients had higher rates of psychiatric admissions. However, long-term use of benzodiazepines in this patient group did not increase the risk of death from all causes or from respiratory events.

Opioids are a key contributor to suicides and drug overdoses—Researchers from the VA Center for Clinical Management Research and the University of Michigan published a 2019 review article that found American adults died by suicide or drug overdose at more than twice the rate they did 17 years ago. The researchers also found that use of opioid medications was a key contributor to that rise in deaths. Opioids are a class of drugs used to treat moderate to severe pain.

Using data from the Centers for Disease Control and Prevention, the researchers showed that the number of deaths from suicide and unintentional overdoses rose from 41,364 in 2000 to 110,749 in 2017. Suicides and overdoses from opioids accounted for more than 41% of such deaths in 2017, up from 17% in 2000. Opioids were implicated in more than two-thirds of all unintentional overdose deaths in 2017 and one-third of all overdose-related suicides.

The researchers believe addressing the problem will take investments in proven treatments for opioid addiction and additional research to identify and better treat Veterans at risk for opioid overdoses.

Suicidal thinking among Veterans—As part of the National Health and Resilience in Veterans study, more than 2,000 Veterans were surveyed on their prevalence of suicidal thinking. The study participants were asked twice, in 2011 and 2013, whether they had experienced suicidal thoughts in the two weeks prior to the survey. A minority, nearly 14%, reported they had.

The results of the 2016 study, led by VA's National Center for PTSD, determined that higher levels of psychiatric distress, physical health problems, and a history of substance misuse predicted chronic suicidal thinking in the study population.

In addition, because many Veterans reported having had suicidal thoughts in one survey but not the other, the researchers determined thoughts of suicide can come and go over time. The study authors said this finding underscored the need for ongoing monitoring of Veterans for suicidal thoughts, not just a one-time screening. Study researchers also found that being connected to others socially could keep some Veterans from thinking about suicide.

Substance use disorders and suicide risk—A team of researchers led by the VA Center for Clinical Management Research in Ann Arbor, Michigan, found in 2017 that Veterans with substance use problems have a higher risk of suicide than those without. They looked at health data for than 4.8 million Veterans and found drug and alcohol problems affected 8% of males and 3% of females in the study population. Veterans with a substance use disorder had more than twice the risk of suicide compared to those who did not.

The suicide rate was especially high among women Veterans with drug or alcohol problems. These women had greater than five times the rate of suicide than women Veterans who did not have substance abuse problems.

Exposure to suicide increases risk—Veterans and active-duty service members who have been bereaved by suicide may be at elevated risk of suicide, according to a 2017 study by researchers at the VA Eastern Colorado Health Care System and the University of Florida. The study's authors found that individuals who were particularly close to a person who died by suicide were at greater risk for future suicidal behaviors themselves.

The authors did not look at how service members and Veterans compared to the civilian population, nor did they study the degree to which service members or Veterans were exposed to suicide.

Insomnia and suicide—A 2012 chart review study of 423 Veterans who died by suicide found that nearly half (173) of those Veterans had a sleep disturbance, such as insomnia, documented by a clinician. The study found that Veterans with a sleep disturbance died sooner after their final visit to a VA facility than those who did not. Researchers with the New York/New Jersey VA Health Care Network Center of Excellence for Suicide Prevention concluded that the presence of a sleep disturbance might pose a near-term risk of suicide. They suggested interventions to address sleep disturbances might be an important way to reduce suicide risk.

In 2016, researchers with the Center of Excellence for Suicide Prevention in Canandaigua, New York, found that cognitive behavioral therapy for insomnia and imagery rehearsal therapy were useful in treating nightmares in combat Veterans with PTSD. The researchers found that combining the two therapies was successful in reducing insomnia, nightmares, depression, and PTSD severity. The researchers said the combination of CBT-I and IRT was a promising treatment for Veterans with combat-related trauma and psychiatric morbidity.

Biomarkers of suicide—VA researchers at the Durham VA Medical Center and the Mid-Atlantic MIRECC found, in a 2014 study, that changes in the levels of certain amino acids in the body may contribute to suicide risk. The amino acids in question are important in regulating people's mood and behavior, although understanding their exact relationships to suicide will require further study.

In 2016, VA researchers at the Rocky Mountain MIRECC for Suicide Prevention in Denver, along with researchers in three other countries, found reduced activity in the enzyme ACMSD in people who have attempted suicide.

The enzyme is part of a chain of biochemical reactions called the kynurenine pathway, which is activated by inflammation. When it behaves sluggishly, it causes abnormal levels of two acids in the body, which could be measured in blood tests to help identify patients at high risk of suicide.

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➤ Responding to suicide risk

While the studies described above and others help clinicians identify patients who are at risk of harming themselves, VA researchers are also considering ways to decrease that risk.

Uridine study—Uridine is a naturally occurring dietary supplement that shares similar brain mechanisms and neural effects with ketamine and lithium, two treatments commonly used to reduce suicidal thoughts. A team of VA researchers led by investigators at the Salt Lake City VA Medical Center is conducting a study to determine whether four weeks of taking uridine is an effective treatment for suicide compared to a group taking a placebo. They are recruiting 90 participants for this study, which is scheduled to be completed in 2023.

Firearms and older Veterans—Among U.S. Veterans, male Veterans aged 55 to 74 account for a disproportionate number of suicide deaths. For all Veterans, a majority of suicides are related to firearms. In a 2020 study, a team led by researchers at the Rocky Mountain MIRECC for Suicide Prevention interviewed 17 Veterans, aged 50 to 70, who were current or former firearm owners or users in order to learn about their experiences and beliefs about firearms.

The researchers identified six themes that could be used to develop safety interventions among older male Veterans. They learned the interviewees’ firearm experiences were usually facilitated by family members and took place at an early age; firearms serve an important social function; these Veterans believe not everyone should have access to firearms; they have preferences for who is involved in firearm safety discussions; and they perceive firearms as useful for protection.

The team hopes these findings may be useful in developing a personalized, effective intervention for Veterans in this age group.

WHO develops promising strategy—The World Health Organization (WHO), a United Nations body, has made suicide prevention a top priority on the global public-health agenda. WHO has developed a program called "brief intervention and contact," providing people who go to an emergency room following a suicide attempt with a one-hour educational session and regular contact with a health care professional after they are discharged.

A team of researchers with the White River Junction VA Medical Center in Vermont and Dartmouth College found in 2017 that this program was linked to significantly lower odds of suicide, based on a literature search. No other suicide prevention technique produced significant effects in reducing suicide, according to the research team. The team recommended additional research into this strategy.

Health-promoting behaviors may reduce suicidal thoughts in Veterans with PTSD—Researchers with the VA Center of Excellence for Research on Returning War Veterans in Waco, Texas, published a 2016 survey of more than 100 Iraq and Afghanistan Veterans with PTSD. They found that Veterans who routinely engaged in activities to foster good nutrition, physical activity, stress management, spiritual growth, health responsibility, and positive interpersonal relationships have a less pronounced link to suicidal thoughts.

The researchers believe that promoting these activities in Veterans with PTSD could help lower their suicide risk.

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More on Our Website

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Selected Scientific Articles by Our Researchers

The association between sexual functioning and suicide risk in U.S. military Veteran couples seeking treatment for post-traumatic stress disorder. Kalifian CE, Knopp K, Wilks CR, Wooldridge J, Sohn MJ, Thomas D, Morland LA. Decreased sexual pleasure and decreased frequency of sexual intercourse were associated with more recent suicidal ideation for male Veterans, whereas increased sexual frequency was marginally associated with increased suicidal ideation for female Veterans. Arch Sex Behav. 2020 Jul;49(5):1601-1613.

Reevaluating suicide mortality for Veterans with data from the VA-DoD mortality data repository, 2000-2010. Hoffmire CA, Barth SK, Bossarte RM. Suicide rates and standardized mortality ratios for Veteran suicide differed between two data sources. Conditions with low base rates can be major public health problems, and minor misclassification can substantially affect surveillance accuracy, prevention efforts, and the validity of study findings. Psychatr Serv. 2020 Jun 1;71(6):612-615.

Evaluation of prevention efforts and risk factors among Veteran suicide decedents who died by firearm. Anderson BA, Reger MA. Veterans who used a firearm for suicide were less likely to have engaged in suicide prevention efforts overall and were less likely to have received lethal means safety counseling or planning. Suicide Life Threat Behav. 2020 Jun;50(3):679-687.

Social determinants and military Veterans’ suicide ideation and attempt: a cross-sectional analysis of electronic health record data. Blosnich JR, Montgomery AE, Dichter ME, Gordon AJ, Kavalieratios D, Taylor L, Ketterer B, Bossarte RM. Integration of social determinants of health in electronic health records could improve suicide prevention. J Gen Intern Med. 2020 Jun;1759-1767.

Integrating crisis response planning for suicide prevention into trauma-focused treatments: a military case example. Rozek DC, Bryan CJ. Using crisis response planning, an evidence-based tool used to prevent suicide attempts, reduced both PTSD symptoms and suicidal ideation. J Clin Psychol. 2020 May;76(5):852-864.

Effectiveness of suicide-focused psychosocial interventions in psychosis: a systematic review and meta-analysis. Bornheimer LA, Zhang A, Li J, Hiller M, Tarrier N. Psychosocial interventions are effective in reducing suicide ideation, plan, attempt, and death among individuals with psychotic symptoms. Psychatr Serv. 2020 Apr 28. (Online ahead of print.)

Suicide mortality and coronavirus disease 2019—a perfect storm? Reger MA, Stanley IH, Joiner TE. COVID-19 may lead to increased risk of suicide. JAMA Psychiatry, 2020 Apr 10. Online ahead of print.

Religion, spirituality, and suicide risk in Iraq and Afghanistan era Veterans. Smigelsky MA, Jardin C, Niewsma JA, Brancu M, Meador KG, Molloy KG, VA Mid-Atlantic MIRECC workgroup; Elbogen EB. Clinical screening for spiritual difficulties may improve detection of suicidality risk factors and refine treatment planning. Collaboration with spiritual care providers, such as chaplains, may enhance suicide prevention efforts. Depress Anxiety. 2020 Apr 5. Online ahead of print.

Early first deployment and risk of suicide attempt among first-term enlisted soldiers in the U.S. Army. Naifeh JA, Ursano RJ, Kessler RC, Allaga P, Herberman Mash HB, Fullerton CS, Ng THH, Dinh HM, Gonzalez OK, Stokes CM, Wynn GH, Kao TC, Sampson NA, Stein MB. Enlisted soldiers deployed within the first 12 months of service have an elevated risk of suicide attempt during and after first deployment. Suicide Life Threat Behav. 2020 Apr;50(2):345-358.

Characteristics and injury mechanisms of Veteran primary care suicide decedents with and without diagnosed mental illness. Simonetti JA, Piegari R, Maynard C, Brenner LA, Mori A, Post EP, Nelson K, Trivedi R. From 2000 to 2014, of nearly 30,000 VHA primary care patients who died by suicide, almost half had no antecedent mental health or substance use diagnosis. J Gen Intern Med. 2020 Mar 26. Online ahead of print.

Effects of electroconvulsive therapy on short-term suicide mortality in a risk-matched patient population. Peltzman T, Shiner B, Watts BV. Patients who received electroconvulsive therapy were at a high risk for suicide. J ECT. 2020 Mar 20. Online ahead of print.

Firearm-related experiences and perceptions among United States male Veterans: a qualitative interview study. Simonetti JA, Holliman BD, Holiday R, Brenner LA, Monteith LL. Male veterans ages 55-74 comprise a disproportionate number of suicide deaths among U.S. Veterans, for whom a majority of suicides are firearm-related. The paper identifies themes relevant to developing firearm-specific lethal means safety interventions among older male veterans. PLoS One. 2020 Mar 10;15(3):e0230135.

Use of the Columbia-Suicide Severity Rating Scale (C-SSRS) in a large sample of Veterans receiving mental health services in the Veterans Health Administration. Katz I, Barry CN, Cooper SA, Kasprow WJ, Hoff RA. Findings support the value of screening and the validity of the self-reports based on the C-SSRS, but limitations in concordance with medical records and variability across programs suggest the need for clinical judgment in interpreting responses. Suicide Life Threat Behav. 2020 Feb;50(1):111-121.

Motivational interviewing to address suicidal ideation: a randomized controlled trial in Veterans. Britton PC, Conner KR, Chapman BP, Maisto SA. Results were nondefinitive in a test of the efficacy of three treatments tailored to Veterans in acute psychiatric hospitalization. Suicide Life Threat Behav. 2020 Feb;50(1):233-248.

Psychosocial protective factors and suicidal ideation: results from a national longitudinal study of Veterans. Elbogen EB, Molloy K, Wagner HR, Kimbrel NA, Beckham JC, Van Male L, Leinbach J, Bradford DW. Psychosocial rehabilitation and holistic approaches may offer a promising avenue for treatment safety planning as well as suicide risk management and prevention. J Affect Disord. 2020 Jan 1;260:703-709.

Awareness of suicide prevention programs among U.S. military Veterans. Tsai J, Snitkin M, Trevisan L, Kraus SW, Pietrzak RH. Veterans aware of VA's Center for Suicide Prevention were younger, male, had more medical conditions, and were more likely to screen positive for posttraumatic stress disorder, generalized anxiety disorder, and past homelessness. Admin Policy Ment Health. 2020 Jan;47(1):115-125.

Associations of lifetime traumatic brain injury characteristics with prospective suicide attempt among deployed US Army soldiers. Campbell-Sills L, Stein MB, Liu H, Agtarap S, Heeringa SG, Nock MK, Ursano RJ, Kessler RC. Among the lifetime TBI characteristics evaluated at predeployment baseline, only past-month postconcussive/post-TBI symptoms were prospectively associated with an increased risk of suicide attempt following deployment. J Head Trauma Rehabil. 2020 Jan/Feb;35(1):14-26.

A randomized controlled trial of public messaging to promote safe firearm storage among U.S. military Veterans. Karras E, Stokes CM, Warfield SC, Barth SK, Bossart RM. There is a need for considerable research and testing before the widespread implementation of public messages to increase the likelihood for desired exposure effects. Soc Sci Med. 2019 Nov;241:112205.

Opioid use disorders, psychiatric comorbidities, and risk for suicide attempts among Veterans seeking pain care. Ashrafioun L, Zerbo KRA, Bishop TM, Britton PC. Addressing opioid use disorders and alcohol use disorders and depression should be addressed together to mitigate the use of suicidal behavior. Psychol Med. 2019 Sep 16;1-6.

The association of pain intensity and suicide attempts among patients initiating pain specialty services. Ashrafioun L, Kane C, Bishop TM, Britton PC, Pigeon WR. Pain intensity is a potentially useful indicator for suicide risk. J Pain. 2019 Jul;20(7):852-859.

An evaluation of the effectiveness of evidence-based psychotherapies for depression to reduce suicidal ideation among male and female Veterans. Kumpula MJ, Wagner HR, Dedert EA, Crowe CM, Day KT, Powell K, Batdorf WH, Shabana H, Kim E, Kimbrel NA. For male Veterans, decreases in suicidal ideation were significantly greater in interpersonal psychotherapy and cognitive-behavioral therapy for depression relative to acceptance and commitment therapy for depression. Women’s Health Issues. 2019 Jun 25;29 Suppl 1;S103-S111.

Brief cognitive behavioral therapy reduces suicidal ideation in Veterans with chronic illnesses. Ecker AH, Johnson AL, Sanshiro S, Fletcher TL, Hundt N, Petersen NJ, Sweeney AC, Chaison AD, York-Ward KM, Kauth MR, Kunik ME, Cully JA. Brief cognitive behavior therapy in primary care reduces suicidal ideation and may help prevent future suicidal ideation. Gen Hosp Psychiatry. 2019 May-Jun;58:27-32.

Transition to suicide attempt from recent suicide ideation in U.S. Army Soldiers: results from the Army study to assess risk and resilience in servicemembers (Army STARRS). Naifeh JA, Usano RJ, Kessler RC, Zaslavsky AM, Nock MK, Dempsey CL, Bartolanzo D, Ng THH, Aliago PA, Zuromski KL, Dinh HM, Fullerton CS, Kao TC, Herberman Mash HB, Sampson NA, Wynn GH, Stein MB. Prospective research examining the transition from suicide ideation to suicide attempts should consider PTSD, intermittent explosive disorder, and education levels. Combat exposure did not differentiate attempters from ideators. Depress Anxiety. 2019 May;36(5):412422.

Relationship between traumatic brain injury history and recent suicidal ideation in Iraq/Afghanistan-era Veterans. Shura RD, Nazem S, Miskey HM, Hostetter TA, Rowland JA, Brenner LA, VA Mid-Atlantic MIRECC Workgroup, Taber KH. Veterans who served after 9/11 with a history of repeated TBIs, versus those who had none, are at much greater risk for considering suicide. Psychol Serv. 2019 May;16(2):312-320.

Hypoxia-related risk factors for death by suicide in a national clinical sample. Riblet NB, Gottlieb DJ, Watts BV, Cornelius SL, Fan VS, Shi X, Shiner B. Chronic hypoxia is a risk factor for suicide and having multiple indicators of hypoxia confers a greater risk for suicide. Psychiatry Res. 2019 Mar;273:247-251.

Suicide risk among Veteran primary care patients with current anxiety symptoms. Shepardson RL, Kosiba JD, Bernstein LI, Funderburk JS. A substantial proportion of primary care patients with anxiety were classified as at risk for suicide, even in the absence of a positive depression screen. Fam Pract. 2019 Jan 25;36(1):91-95.

Shame as a mediator between posttraumatic stress disorder symptoms and suicidal ideation among Veterans. Cunningham KC, LoSavio ST, Dennis PA, Farmer C, Clancy CP, Hertzberg MA, Kimbrel NA, Calhoun PS, Beckham JC. Shame may be an effective point of treatment intervention to reduce suicidal ideation among Veterans with PTSD. J Affect Disord. 2019 Jan 15;243:216-219.

Understanding links among opioid use, overdose, and suicide. Bohnert ASB, Ilgen MA. Opioid use plays a critical role in fueling rates of suicide and unintentional overdose. Interventions that address the shared causes and risk factors have the potential to be high-value investments by addressing both problems simultaneously. N Engl J Med. 2019 Jan 3;380(1):71-79.

Risks of benzodiazepines in chronic obstructive pulmonary disease with comorbid posttraumatic stress disorder. Donovan LM, Malte CA, Spece LJ, Griffith MF, Feemster LC, Engelberg RA, Au DH, Hawkins EJ. Short term use of benzodiazepines in Veterans with COPD and PTSD can pose a mortality risk. Suicide associated with benzodiazepine use in this population warrants further investigation. Ann Am Thorac Soc. 2019 Jan;16(1):82-90.

A genome-wide association study of suicide attempts and suicidal ideation in U.S. military Veterans. Kimbrel NA, Garrett ME, Dennis MF, VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup; Hauser MA, Ashley-Koch AE, Beckham JC. There is an association between gene KCNMB2 and suicide attempts. Another gene, ABI3BP, may be linked to suicide attempts and suicidal thoughts. Psychiatry Res. 2018 Nov; 269:64-69.

Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department. Stanley B, Brown GK, Brenner LA, Galfalvy HC, Currier GW, Knox KL, Chaudhury SR, Bush AL, Green KL. The safety planning intervention is associated with a reduction in suicidal behavior and increased treatment engagement among suicidal patients following emergency department discharge. JAMA Psychiatry. 2018 Sep 1;75(9):894-900.

Suicidal ideation and behavior in U.S. Veterans with schizophrenia or bipolar disorder. Harvey PD, Posner K, Rajeevan N, Yershova KV, Aslan M, Concato J. A history of suicidal ideation or behavior is common among Veterans with schizophrenia or bipolar disorder, and specific demographic and clinical attributes correlate with variation in risk. J Psychiatr Res. 2018 Jul;102:216-222.

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Suicide Prevention Fact Sheet

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