Post-9/11 veterans saw suicide rates soar in the years before pandemic, study finds

A silent epidemic of suicides stalked the nation’s military veterans even before the COVID-19 global shutdown. A government-funded study released Monday found that suicide rates among veterans who served in the aftermath of the September 2001 terrorist attacks soared more than tenfold during the 14 years before the pandemic.

In a study funded by the Department of Defense and the Department of Veterans Affairs, six researchers in the study published in the journal JAMA Neurology found a quickly widening disparity in death rates by suicide between post-9/11 veterans and the general U.S. adult population from 2006 through 2020, the most recent year of data available.

Reports have long shown that veterans who have sustained traumatic brain injuries are more likely to die of suicide than other former service members, but researchers found that rates grew annually for both groups at about the same startling pace.

The latest finding suggests that those who served in uniform after the September 11 attacks faced far more challenges than previous generations in adjusting to life after military service.

The study builds on research showing worse health outcomes for post-9/11 veterans and underlines the need for “a more holistic approach” to a growing problem, said co-author Jeffrey T. Howard, a public health professor at the University of Texas at San Antonio.

“I think it speaks to breakdowns in the cohesion of our society, a lack of opportunities for many communities, and a lack of social support and meaning for a lot of people,” Mr. Howard told The Washington Times. He noted a need for family and friends to help veterans readjust to civilian life.

Among 2,516,189 patients who received care from the Military Health System and Veterans Health Administration from 2006 to 2020, the suicide rate surged from 7.11 to 90.81 deaths per 100,000 post-9/11 veterans with traumatic brain injuries, an annual average of 14.8%.

For veterans without brain injuries, the rate increased by an annual average of 14.4%, from 4.65 to 55.65 suicides per 100,000.

The suicide rate for all adults over the same years grew at an annual average of 1.2%, from 15.97 to 19.26 per 100,000 people.

Researchers calculated that the 8,262 suicides among post-9/11 veterans and 562,411 among all adults from 2006 through 2020 added up to rates of 42.13 and 18.42 deaths per 100,000 people, respectively.

Mr. Howard noted that common suicide risks include drug or alcohol abuse, post-traumatic stress disorder, depression, anxiety, sleeplessness and a loss of social support after military service.

In a statement emailed to The Times, a VA spokesman touted several recent initiatives to reduce veteran suicides.

They include expanding emergency suicide care, partnering with more than 1,000 local suicide prevention coalitions, and linking the Veterans Crisis Line to the 988 Suicide and Crisis Lifeline, which the federal government launched in July 2022. In January, the VA issued a rule allowing veterans facing an “acute suicidal crisis” to go to any VA or non-VA health care facility for emergency health care, including inpatient or residential care for up to 30 days and outpatient care for up to 90 days. There is no cost to the patient, and veterans do not need to be enrolled in the VA system to use the benefit, the department said.

“We at VA are studying this report and will use the findings to continue to improve our suicide prevention efforts,” said Terrence Hayes, VA press secretary. “One veteran who dies by suicide will always be one too many, and ending veteran suicide is VA’s No. 1 clinical priority.”

Mr. Hayes noted that VA data shows suicides among all veterans dropped by 343, from 6,489 in 2019 to 6,146 in 2020 — the lowest number since 2006 — even as the rate increased among veterans ages 18 to 34.

Cause for alarm

The findings are alarming to some psychologists and mental health experts not involved in the study.

“It would be hoped that, on the basis of such troubling statistics, the VA would take all necessary steps to level off and reduce these suicide rates among our veterans,” Jack Van Horn, a brain researcher who teaches psychology and data science at the University of Virginia, said in an interview.

Mr. Van Horn said the symptoms of traumatic brain injuries — including decreased self-esteem, sleeplessness, anxiety, irritability and impaired brain function — are often indistinguishable from PTSD, adding to the depression and social problems that push some veterans toward suicide.

“Injuries to the brain — from concussions in a vehicular accident to battlefield-related injuries — are a significant and life-altering medical concern,” he said.

Timothy Jansen, CEO of Community Crisis Services Inc., a 988 call center in Hyattsville, Maryland, noted that post-9/11 veterans underwent multiple deployments during extended wars in the Middle East. The Great Recession brought on by the Wall Street financial crisis of 2008 sent jobless rates soaring and undermined personal finances for years.

He said many of those veterans, especially men, have avoided asking for help with suicidal thoughts because they view it as a sign of weakness.

“We must work to train everyone to not be shy about asking if someone is struggling with thoughts of suicide,” said Mr. Jansen, a licensed social worker. “We have to work to end the stigma surrounding suicide so that we can finally find some long-term solutions.”

Mr. Howard, the study’s co-author, said more research is needed to explain why suicide rates grew so much faster for post-9/11 veterans than for the general population — and to see whether the gap has widened since the pandemic.

The study found that the suicide rate among all U.S. adults was unchanged at 19.26 deaths per 100,000 people from 2019 to 2020 as the U.S. implemented COVID lockdowns of schools, businesses and nonessential medical care.
 
Over the same two years, the suicide rate grew from 80.16 to 90.81 per 100,000 people for post-9/11 veterans with traumatic brain injuries and from 49.82 to 56.65 per 100,000 veterans without brain injuries.

“It is not clear if this continued into 2021 and 2022, but that is something we will examine when the data are available,” Mr. Howard said.