Veterans at a Lower Risk of Suicidal Behavior During COVID-19 Pandemic

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For participants reporting past-year suicidal experiences, there was decreased odds of attributing their suicidal experiences to the pandemic for veterans compared to nonveterans.

Veterans had a decreased prevalence of suicide during the COVID-19 pandemic compared to the general population.1

A team, led by Ian H. Stanley, PhD, Center for COMBAT Research, Department of Emergency Medicine, University of Colorado School of Medicine, compared the rates of suicide attempts and plans between Veterans and civilians.

Suicide Rates

The age- and sex-adjusted suicide rate has been higher for US veterans compared to nonveterans in the past 2 decades. In addition, the COVID-19 pandemic has increased concerns over the suicide risk of many groups, including veterans.

However, the US experienced population-level declines in the suicide rate in 2019 and 2020, with declines even greater among veterans (9.7%) than in nonveteran adults (5.5%).

“Veterans may have experienced a differential effect of the COVID-19 pandemic on suicide rates or proxy indicators, such as suicide ideation, plans, and attempts,” the authors wrote.

The Comparison

In the cross-sectional study, the investigators identified data from the 2021 National Survey on Drug Use and Health (NSDUH), a representative survey of noninstitutionalized US civilians aged 12 years and older and analyzed responses from adult participants.

Veterans were asked if they made a suicide plan or suicide attempt during the past 12 months. They were then asked if it was because of the COVID-19 pandemic and how much the COVID-19 pandemic has negatively impacted their emotional or mental health.

The investigators used logistic regression analyses to examine the association between veteran status and COVID-19-related suicidality or adverse mental health, controlling for age and sex.

They used NSDUH-calculated sampling weights in the analyses.

Overall, there were 47,291 adults included in the study, 7.8% of which were veterans.

The results show 4.8% of the patient population reported suicide ideation, 1.3% had suicide plans, and 0.7% attempted suicide in the past year. For veterans, there were increased odds of reporting past-year suicide ideation (adjusted odds ratio [AOR], 1.42; 95% confidence interval [CI], 1.41-1.42), suicide plans (AOR, 1.97; 95% CI, 1.96-1.98), and suicide attempts (AOR, 2.94; 95% CI, 2.92-2.95).

On the other hand, for participants reporting past-year suicidal experiences, there was decreased odds of attributing their suicidal experiences to the pandemic for veterans compared to nonveterans (suicide ideation: AOR, 0.53; 95% CI, 0.52-053; suicide plans: AOR, 0.45; 95% CI, 0.44-0.46; suicide attempts: AOR, 0.39; 95% CI, 0.38-0.39).

Veterans were at a decreased odds of reporting adverse mental health, broadly, related to COVID-19 compared with nonveterans (AOR, 0.89; 95% CI, 0.89-0.89).

“There is no single contributing factor to suicidal thoughts and behaviors,” the authors wrote. “However, in this cross-sectional study, US veterans were at 47% to 61% decreased odds compared with nonveterans of attributing their past-year suicidal experiences to the COVID-19 pandemic.”

The investigators presented some explanations.

“Veterans may be resilient to the psychosocial sequelae of tragedies, such as COVID-19, perhaps due to their military experiences,” the authors wrote. “Nevertheless, our findings suggest that veterans continue to experience disparities in the prevalence of past-year suicidal thoughts and behaviors, underscoring the need for a multilayered suicide prevention approach.”


Stanley IH, Flarity KM, April MD. Suicide Ideation, Plans, and Attempts Attributed to the COVID-19 Pandemic Among US Veterans. JAMA Netw Open. 2023;6(6):e2320193. doi:10.1001/jamanetworkopen.2023.20193