Introduction
Suicidal behavior, which includes repeated thoughts and feelings of ending one’s life (suicide ideation); the actual incident of trying to end one’s life (suicide attempt); or ending one’s life (completed suicide), is more prevalent in veterans diagnosed with Post Traumatic Stress Disorders (PTSD) and other psychiatric disorders like depression and anxiety than in normal veterans. Data from the Department of Veteran Affairs (VA) as of January 2010 showed that the suicide rate amongst the United States military veterans had significantly increased (26% increase) in the period from 2005 through to 2007 (Bruce, 2010). According to VA estimates, the rate of suicide per 100,000 veterans aged 18-29 years had increased from 44.99 in 2005 to 56.77 in 2007 (Bruce, 2010). Moreover, the secretary of VA (Eric Shinseki) stated that approximately 20% of the over 30,000 annual suicide related deaths in the US are acts by veterans. This translates to about 18 veterans committing suicide every day (Bruce, 2010). This disturbing new trend is in line with a 2008 report from a Blue Ribbon Work Group that amplified the veteran suicidal tendencies awareness of the VA. The report was quite extensive in that it covered the population of the veterans in its entirety: it included veterans who utilize the health and mental health services furnished by the Veterans Health Administration (VHA) as well as those who did not utilize the services (Bruce, 2010).
The above data apparently shows that, over the years, veterans have had an increased risk of committing suicide; however, due to the huge and diverse nature of the veteran population, an important question still begs for answers: which group of veterans, as compared to another group of veterans, has an increased risk of suicide? The wholesome population of the veterans includes soldiers who served in World War II, the Vietnam War, the Korean War, the Gulf War, Operations Enduring Freedom and Iraqi Freedom (OEF and OIF). In order to fully comprehend the disturbing trend among the veterans, therefore, we need to look into and identify the factors associated with an increased risk of suicide among these groups of veterans (Bruce, 2010). Thereupon, the objective of this paper is to examine the suicide trends across the different groups of veterans in order to determine which particular group of veterans are most predisposed to suicidal behavior as compared to the other groups.
Veterans Increased Suicide Risk Assessment
To achieve the objective of this paper, we will look at some of the available data on suicidal trends in all veterans, Vietnam War Era Veterans, and OEF/OIF veterans.
1. All Veterans: an analysis of a representative sample data of veterans from the National Health Interview Survey 1986-1994 compared to the National Death Index up to 1997 by Kaplan et al. indicates that veterans had a statistically noteworthy 2.3 increased risk of suicide compared to the general population. In general, suicidal veterans were majorly white, 65 years of age or older, and took their lives by firearms (Kaplan et al., 2007). PSTD incidences and other mental health disorders were more common in veterans who had experienced combat during their military service years (Koven, 2017). In this case, combat does not mean the same thing for each veteran. The combat events differ significantly across the veteran groups and so does the meaning of the combat event to each veteran. Combat generally refers “to the subjective, often unconscious perception of the traumatic event, and includes the affective state of the veteran before the event took place, when it took place, and the affects experienced subsequently” (Hendin, 2014, p. 583).
Therefore, the way in which each veteran experienced the events of the combat is very important in suicidal behavior risk assessment. In general, veterans who had experienced chaotic and bloody combats were more likely to suffer from PTSD, severe guilt, depression, and anxiety as a direct consequence of the combat events (Kang et al., 2015). Additionally, “indirect evidence of possible pathways from deployment exposure to increased suicide risk arises from a link between combat exposure and PTSD and observations of increased suicide risk among veterans with PTSD (Kang et al., 2015, p. 99). In a nutshell, therefore, suicide risk is higher in veteran population relative to the general US population, and the risk is even higher in veterans with mental disorders which are generally tied to the degree of combat exposure. According to a recent research, “veterans who screened positive for PTSD were more than four times as likely to endorse suicidal ideation relative to non-PTSD veterans” (Jakupcak et al., 2009, p. 303).
2. Vietnam War Era Veterans: some studies have noted an increased relative risk (RR) of suicide among Vietnam Veterans sub-groupings. For instance, statistics indicate a 1.76 increased risk of engaging in suicidal behavior among veterans who were deployed in Vietnam relative to veterans of the same period who were not directly involved in the war (Bruce, 2010). The increased risk of suicide was attributed to several aspects of the combat experience in Vietnam. Among the leading aspects was PTSD which accounted for 6.74 of the standard mortality rate (SMR), and war wounds and injuries accounting for 12.58 of the SMR (Bruce, 2010). VA estimates that approximately 31% of the Vietnam War Era veterans suffer from PSTD (Koven, 2017). With other mental health disorders unaccounted for, this represents a huge number of the veterans. Since the veterans who were deployed to Vietnam commit suicide at a higher rate than veterans who were not deployed to Vietnam, and a significant portion of the deployed veterans are afflicted by PTSD comorbid with other psychiatric disorders, we can reasonable conclude that suicidal tendencies are more prevalent in veterans diagnosed with PTSD and comorbid mental disorders relative to normal veterans.
3. OEF/OIF Veterans: the risk of committing suicide for OEF/OIF active duty veterans, relative to the general population was greater by 33% (SMR of 1.33) as of December 31, 2005 (Kang et al., 2015). Of much interest, however, is the fact that among the veterans who had been diagnosed with some sort of mental disorder, the suicide risk was much greater: SMR of 1.77, 1.01-2.97 (Bruce, 2010). In essence, these numbers show that even though suicidal behavior is generally higher in veterans compared to the general population, the risk of suicide is even much higher in veterans diagnosed with mental disorders like PTSD. In total, approximately 31% of veterans from OEF/OIF are afflicted by PSTD (Koven, 2017), other common mental illnesses not accounted for. Based on these facts, it is clear that veterans with PTSD comorbid other mental disorders are more likely to engage in suicidal behavior compared to mentally fit veterans, indicating a very strong correlation between PTSD comorbid other mental disorders and suicidal tendencies among veterans.
Summary
The inescapable truth in this study is the fact suicidal behavior among veterans has been increasing at an alarming rate (an increase 26% in just over two years). Indeed, this calls for some measures of intervention to be put in place. In order for such measures to be fruitful, it is imperative that we understand the factors that increase the risks of suicidal behavior among the veterans. The study has explored the most significant groups of veterans in the US and the following are some of the key points discussed:
a) Relative to the general population, veterans have a statistically noteworthy 2.3 increased risk of suicidal behavior.
b) Among the Vietnam War era veterans, veterans who were deployed to Vietnam were more predisposed to suicide behavior compared to their counterparts who were not deployed (an increased risk of 1.76). Furthermore, a significant number of the deployed veterans were afflicted by PTSD comorbid other mental disorders. A cross analysis of the two facts, therefore, yields a reasonable conclusion that suicidal behavior is more prevalent in veterans suffering from PTSD comorbid other mental orders than in normal veterans.
c) Relative to the general population, the veterans of the OEF/OIF era were 33% more likely to commit suicide. A comparison among the veterans themselves indicates that veterans who had been diagnosed with some form of mental illness were more likely to attempt or commit suicide than a mentally fit veteran.
Conclusion
This study reveals that whereas there is an increased risk of suicidal behavior among veterans compared to the general population, the risk of suicidal behavior is even higher in veterans diagnosed with PTSD and other comorbid mental disorders.
References
Bruce, M. L. (2010). Suicide risk and prevention in veteran populations. Annals of the New York Academy of Sciences, 1208(1), 98-103.
Hendin, H. (2014). An innovative approach to treating combat veterans with PTSD at risk for suicide. Suicide and life-threatening behavior, 44(5), 582-590.
Jakupcak, M., Cook, J., Imel, Z., Fontana, A., Rosenheck, R., " McFall, M. (2009). Posttraumatic stress disorder as a risk factor for suicidal ideation in Iraq and Afghanistan war veterans. Journal of traumatic stress, 22(4), 303-306.
Kang, H. K., Bullman, T. A., Smolenski, D. J., Skopp, N. A., Gahm, G. A., " Reger, M. A. (2015). Suicide risk among 1.3 million veterans who were on active duty during the Iraq and Afghanistan wars. Annals of epidemiology, 25(2), 96-100.
Kaplan, M. S., Huguet, N., McFarland, B. H., " Newsom, J. T. (2007). Suicide among male veterans: a prospective population-based study. Journal of Epidemiology " Community Health, 61(7), 619-624.
Koven, S. G. (2017). PTSD and Suicides Among Veterans—Recent Findings. Public Integrity, 19(5), 500-512.
