The annual survey of veterans by the Wounded Warrior Project (WWP) found encouraging signs on home ownership and access to Department of Veterans Affairs care, while pointing up disturbing trends in suicidal thoughts, burn pit exposure and sexual assaults.
For the first time in its 10-year history, the WWP survey included questions about exposure to toxic substances: 70% of respondents said "they were definitely exposed in their time of service" to burn pits and other sources of toxins, said Dr. Melanie Mousseau, WWP's director of metrics.
About 30% said they had registered with the VA's Burn Pit Registry, "but only 9% have currently sought treatment," she said in a briefing for reporters ahead of the survey's release Wednesday.
Another new section of the survey dealt "specifically with thoughts of suicide," Mousseau said, adding that "an alarming number of 33% of our warriors" said they had suicidal thoughts.
In a follow-up email, she cited two other studies in which more than 30% veterans said they had suicidal thoughts, while a separate study of the general population showed the rate of suicidal thoughts at about 9%.
"We don't have the answers of the 'why' behind it," Mousseau said of the prevalence of suicidal ideation among veterans.
Related: Help Prevent Veteran Suicide
Another "critical finding" in the survey was the increase in the percentage of respondents who said they had been victims of sexual assault or trauma.
In the survey five years ago, about 32 percent reported experiencing sexual assault; that increased to 42% in the 2019 survey, underscoring that "female veterans' issues are priorities" going forward, Mouseau said.
The survey also showed that obesity remains common among veterans and is increasing. "This year, 52% of our population is obese," compared to about 40% in the survey 10 years ago and about 40% currently in the general population, she said.
Overall, the survey's findings show that "the needs are real, they're great, [and] they're growing" in the veterans community, Mousseau said.
"The challenges are real," but in the last three months "we also see that over half of those that we serve are seeking mental health support for emotional issues," she added.
She sees that as a "positive data point," but "there's still obstacles getting in the way for some in getting the care they need. We're not going to ever see the number of PTSD [post traumatic stress disorder] injuries decline," but more veterans are learning to manage and cope with it, Mousseau said.
The web survey was fielded to 109,968 recipients registered with WWP, about 7% of them active duty; 35,908 warriors completed the 30-minute survey. The response rate was 32.7 percent, down a percentage point from the 2018 survey.
The average age of respondents was 42, WWP said; 83% were male, 65.9% were married, 64.1% were white, 37.1% had a bachelor's degree or higher, 54% were from the South and only 9.6% from the Northeast.
Almost half of respondents (47.3%) had deployed three or more times during their military careers, and almost all who had deployed since 2001 did so at least once to a combat area (92.5%).
The percentage of warriors receiving benefits from the VA was the same as in the 2018 survey at nearly 90%.
More than six in 10 warriors -- 64.8% in 2019 and 61.7% in 2018 -- had disability ratings of 80 percent or higher, the survey found. The percentage reporting pending claims or claims on appeal at VA remained nearly steady -- 2.9% in 2019 versus 2.5% in 2018.
The most common self-reported injuries and health problems all showed increases in the 2019 survey.
Sleep problems were the most reported at 87.5% (75.4% in 2018); PTSD, 82.8% (78.2% in 2018); anxiety, 80.7% (68.7% in 2018); back, neck or shoulder problems, 76.8% (73.7% in 2018); and depression, 76.5% (70.3% in 2018).
However, WWP cautioned that the increases in the most common self-reported injuries could reflect a change in the way the survey was done.
"For 2019, injuries were broken into lists of physical and mental injuries, while in previous years, injuries were presented in one column," according to the WWP.
The survey showed that more 93.7% of respondents said they sustained severe physical injuries during military service, with 92.8% percent reporting more than one such injury.
The most commonly reported severe physical injuries were back, neck or shoulder problems (76.8%), tinnitus (60.7%), knee injuries or problems (55.7%), migraines (53.4%), and severe hearing loss (52.5%).
Body mass index (BMI) scores showed that the majority (51.7%) of warriors were obese, putting them at higher risk for additional health problems including Type 2 diabetes, heart disease and stroke, kidney disease and sleep apnea.
The percentage of those who were morbidly obese changed little -- 45.6% in 2019 and 45.5% in 2018.
Among the 75.0 percent of warriors who drank alcohol in the past year, 44.0 percent of female warriors and 48.4 of male warriors scored positive for risky drinking behavior, meaning that they drank to the point of risking medical or social problems, the survey said.
More than half of all warriors reported visiting a professional to get help with issues such as stress, emotional, alcohol, drug or family problems in the past three months, but access to care was an issue.
"Almost one-third of warriors (31.8% in 2019 and 32.8% in 2018) had difficulty getting mental health care, put off getting such care, or did not get the care they needed," the survey showed.
More than one-third of warriors (35.0% in 2019 and 37.3% in 2018) indicated that conflicts between their personal schedules and hours of operation at VA sites were the reason they had difficulty getting mental health care.
Others reported feeling that treatment might bring up painful or traumatic memories that they wanted to avoid (32.2%).
On the subject of jobs, more than 60% of warriors were employed, and most were working full-time. The labor force participation rate was 62.6%, with 48.8% of warriors employed full-time, 7.3% employed part-time, and 6.6% self-employed.
For those warriors who are not in the labor force, the primary reasons included mental health injury (31.4%), physical injury (19.0%), retirement (18.1%), or current enrollment in school or a training program (11.1%).
In addition, 3.4 percent of warriors who are not in the labor force have become too discouraged to continue looking for work, and 3.4 percent have family responsibilities that prevent them from working, the survey showed.
Home ownership continued to rise, according to the survey. Among warriors, 61.3 percent own homes, with or without a mortgage balance. The survey showed that 57.1% currently own their own homes with an outstanding mortgage, continuing a three-year upward trend.
About 4.2 percent own their homes with no mortgage balance, and 26.3% rent their homes.
-- Richard Sisk can be reached at Richard.Sisk@Military.com.