A two-year study from Veterans Affairs (VA) reveals that nearly 14 percent of veterans reported suicidal thinking either at the beginning or end of a recent evaluation.
Investigators surveyed more than 2,000 U.S. veterans on two occasions as part of the National Health and Resilience in Veterans Study. Dr. Robert Pietrzak of the Clinical Neurosciences Division of VA’s National Center for PTSD led the study with the first wave conducted in 2011, and the second in 2013.
For both the first and second wave of the study veterans were asked whether they had experienced suicidal thoughts in the past two weeks. They answered a host of other questions as well, enabling the researchers to glean insights about factors associated with suicidal thinking.
About 86 percent of the veterans denied having any such thoughts, both times they were asked. About five percent had “chronic” suicidal thinking: These veterans reported suicidal thoughts in the past two weeks both times they were surveyed, two years apart.
Nearly four percent had “remitted” suicidal thinking: They reported suicidal thoughts in wave one but not wave two. And five percent reported the converse: They reported such thoughts only during the second survey.
Combined, 13.7 percent of the total sample reported suicidal thinking at either or both time points.
The study results currently appear online in the Journal of Affective Disorders and will follow in hard copy.
Experts admit that it is difficult to compare this prevalence rate to that of U.S. adults in general. Studies on suicide vary widely in their methods–for example, how questions are worded, and the time frames they cover. And studies often focus on particular age brackets or other subgroups.
One general reference point might be a study by the Centers for Disease Control and Prevention, published in 2011, in which 3.7 percent of U.S. adults reported having suicidal thoughts in the past year.
By that yardstick, the rates in the new study are high.
If true, the findings would be similar to other research showing that a greater proportion of veterans experience suicidal thinking — as well as attempts, and deaths by suicide — relative to the general population.
One oft-cited VA study found that veterans, while making up only about 13 percent of U.S .adults, account for about 22 percent of suicides. Another study, from 2007, found that compared to civilians, veterans were twice as likely to die by suicide.
In any case, the new results offer some divergent insights.
For example, the new findings suggest suicidal ideation can come and go, at least within the span of a couple of years. This challenges past findings that associated suicidal thinking as being a longer-term problem.
“Our results … highlight the dynamic nature of [suicidal ideation],” write the researchers, “as evidenced by the meaningful proportion of U.S. veterans reporting changes in suicidal ideation over time.”
The finding are meaningful in that they underscore the need for ongoing periodic monitoring — not just a one-time screening, say the investigators.
Among those veterans who reported suicidal thinking only during the second wave, 65 percent had never engaged in any mental health treatment. The researchers say this is another finding that points to the need for more outreach.
Not surprisingly, higher levels of psychiatric distress, physical health problems, and substance use history predicted chronic suicidal thinking.
Social connectedness — widely seen as a major buffer against suicide risk — emerged in the study as a factor associated with the remission of suicidal thinking. By the same token, veterans who reported less social support at wave one were also more likely to report the onset of suicidal thinking at wave two.
Investigators were surprised that for many of the veterans reporting chronic suicidal thinking, social support did not appear to be as beneficial as expected. The researchers say that for these veterans, addressing psychiatric and physical health, and substance use problems, may be more critical.
The research team points to several limitations in their study.
For one, it covered only a two-year period, so the researchers can’t draw conclusions about the longer-term course of suicidal thinking.
Also, a third of the sample who responded to wave one did not complete the wave two survey. If those who dropped out were in fact more likely to be troubled by suicidal thinking than those who stayed with the study, that could mean the prevalence of suicidal thinking was underestimated.
Another limitation was that the survey did not ask about certain factors that could add to the understanding of what drives suicidal thinking, such as financial and interpersonal stress.
Overall, the researchers say the findings highlight the importance of ongoing assessment of mental and physical health problems. They also call for bolstering sources of social support to help prevent suicidal thinking — and to promote its remission — in veterans.