The number of veterans who died by suicide in 2018 increased slightly from 2017 and data so far for 2020 does not indicate an increase in veteran suicides during the pandemic, according to the Department of Veterans Affairs' annual report released Thursday.
That report was released late this year. In prior years, the department released the report in September or October. VA and the White House denied that the report's delay was related to the election.
The number of veterans who die by suicide has remained largely stagnate or worsened in recent years, despite increased spending and programs aimed at preventing those losses. The data typically lags behind by about two years, making it difficult to determine whether efforts have made a significant difference year over year. For 2020 specifically, lawmakers and advocates worried the data lag could mean a lack of understanding of how the pandemic affected veteran suicides.
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More than 6,300 veterans died by suicide each year from 2008 to 2018, according to prior reports.
In 2018, 6,435 veterans died by suicide, an increase of 36, or .6% from 2017's 6,399. During that same time, the veteran population decreased by about 1.5% or roughly 300,000 (20.4 million to 20.1 million). That rate of suicide among the overall U.S. adult population also continues to increase.
For 2020, "suicide deaths, rates and trends during the COVID-19 pandemic cannot accurately be determined at this point in time," the report said, though VA noted it found no significant increases in veteran suicide attempts or deaths among veterans receiving care through the department so far. But VA also noted that it's unsure how closures of VA facilities or other restrictions may have affected data collection.
VA characterized the 36 additional deaths in 2018 as "not a significant increase" for the overall veteran suicide rate, which rose from 17.5 per day in 2017 to 17.6 per day for 2018.
Those daily figures vary from the 2019 report that showed 6,139 veteran suicides in 2017, a rate of about 16.8 per day. In a footnote of its report, VA explained that the updated number is "primarily due to improvements in the assessment of whether former service members had been federally activated, a criterion for the federal definition of veteran status" other changes were related to better search and matching information of CDC, VA and Defense Department data, the report said. The lag in veteran suicide data is largely due to VA having to rely largely on CDC data since veterans are civilians.
VA's 2017 report included a significant change in how the department calculated the suicide rate, focusing only on veterans as defined by those who had been federally activated for service, removing National Guard and Reserve veterans who were never federally activated from the daily average count. About 1.5 of those veterans died by suicide daily in 2017, according to to 2020 report, though the 2019 report recorded 2.5 suicide deaths per day for those same veterans.
Veterans disproportionately die of suicide in the United States, and that gap has worsened. In 2018, veterans accounted for 14% of American suicide deaths though they make up only about 7% of the overall population. The veteran suicide rate was 1.5 times the rate for non-veteran adults in 2018, after adjusting for differences in age and sex.
While the veteran population overall is decreasing, the suicide rate among them is still increasing. In 2005, 6,056 veterans died by suicide, rising 6.3% to 2018's 6,435 deaths, even though the number of American veterans decreased by 4.4 million during that same time, down to 20.1 million in 2018.
The total number of veteran suicide deaths increased by .6% from 2017 to 2018, despite a 1.5% decrease in the overall veteran population during that same time period (20.4 million to 20.1 million).
From 2005 to 2018, the number of veteran suicide deaths each year was lowest in 2006 and highest in 2014.
Veterans accounted for a lower proportion of suicide deaths among American adults in 2018 than in prior years -- about 13.8% compared to 14.1% in 2017.
In 2005, about 16.6 veterans died by suicide daily. In 2018, 17.6 veterans died each day, on average, according to VA's report.
VA care
Veterans who received recent care from VA correlated with a decrease in suicides compared to veterans who did not access VA care. The suicide rate among veterans who recently received care from the Veterans Health Administration decreased 2.4% in 2018 while the rate among veterans who had not accessed VHA rose by 2.5%, though in a footnote VA's report said the difference "was not statistically significant."
"The data shows the rate of suicide among veterans who recently used VA health services has decreased, an encouraging sign as the department continues its work and shares what we learn with those who care for and about veterans," VA Secretary Robert Wilkie said in a statement Thursday.
While VHA patients diagnosed with depression and anxiety saw an overall drop in their rate of suicide from 2005 to 2018, those rates increased from 2017 to 2018.
The 2020 report showing 2018 data was the first time VA included a breakdown of its suicide data by race and gender.
Fewer women in VA care died by suicide in 2018 than 2017 -- from 94 to 81, though more women are utilizing VA overall. The suicide rate for women veterans who did not receive VA care was unchanged from 2017.
Suicide rates were lower among Black veterans than white veterans, according to the report.
"VHA is working to understand and address health care disparities for veterans, including in VHA mental health care," the report said, adding that "ongoing work is needed to understand ... veteran suicide including differences by race and ethnicity."
Firearms were by far the leading method of suicide for veterans in 2018 at 69.4%, of male veteran deaths and 41.9% of women veteran deaths, according to the report. Firearms are used in about 48% of suicides among Americans overall. VA officials said they opposed bills introduced by Democrats on the House Veterans Affairs Committee that aimed to increase lethal means training and curb deaths by firearms.
Suicide risk
VA outlined in its report major factors that contribute to veterans' suicide risk, including poverty, unemployment, homelessness and more.
In April 2020, amid the coronavirus pandemic, there were 833,000 more unemployed veterans than in April 2019, increasing the risk of housing insecurity.
While U.S. suicide rates are typically highest among Native Americans and Native Alaskans, followed by white Americans, during the COVID-19 pandemic, VA said the rate of suicidal ideation "in the last 30 days was noted to be significantly higher for certain populations, including racial and ethnic minority populations" such as Hispanic and Black Americans.
Veterans with LGBT or related identities also experience elevated suicide risk, according to the report, and are more likely to screen positive for post-traumatic stress disorder, depression and alcohol than heterosexual veterans.
Veterans' health is another potential indicator of suicide risk.
VA patients who died by suicide were more likely to have sleep disorders, traumatic brain injuries or a pain diagnosis compared to other VA patients.
Mental health diagnoses are also linked to higher suicide risk, including depression, bipolar disorder, anxiety disorders, substance use disorder, schizophrenia, inpatient mental health care and more. Nearly 60% of veterans who died by suicide had a diagnosed mental health condition, according to the report.
Social isolation is a major risk factor for suicide and "is a significant concern given social distancing practices to reduce the spread of COVID-19," according to the report.
Among VA patients, suicide rates are highest among those who are divorced, widowed or who never married. Veterans who live in rural areas also face higher suicide risk.
"Many facets of life during the COVID-19 pandemic may result in increased feelings of loneliness, sadness, fear, and anxiety: constant references to mortality; social distancing from friends and loved ones; economic recession and job loss; disruption of daily routines; concerns about shortages of food and medical supplies; and a general sense of powerlessness," according to the report.
To support veterans during the pandemic, VA expanded its telemental health capacity for video and phone appointments and released information to help educate veterans on how to maintain mental wellbeing during the pandemic, including the new COVID Coach mobile app.
Overall, VA's report said the department's data did not indicate increases in veteran suicide deaths or attempts during the pandemic, but "monitoring is ongoing."
"Whether the setting is an individual’s heart and mind or that of our broader community, it is imperative that hope prevails over despair," the report said, calling for implementation of a national plan for suicide prevention for veterans and all Americans. "Suicide is preventable, but should not be an issue of counterproductive blame or shame. Suicide prevention will require a public health approach unifying clinical, community and academic domains."
President Donald Trump and Wilkie unveiled the President's Roadmap to Empower Veterans and End a National Tragedy of Suicide (PREVENTS) plan and campaign in June.
"It will point the way for the rest of the country," Wilkie said of the plan at the June press conference. "This is the beginning of one of the most important national discussions ... it is an effort to find a solution to a problem that does not discriminate among victims, poor, rich, people of all races and creeds."
The president said he was "marshaling every resource to stop the crisis of veteran suicide."
"You'll see things happen that no one would ever think was possible," he promised.
Neither the White House nor the transition team for President-elect Joe Biden immediately responded to requests for comment on Thursday.
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