Suicides among U.S. veterans were down in 2020 by nearly 10% from a peak in 2018 and have dropped to their lowest level since 2006, according to Department of Veterans Affairs data, in a trend that agency officials say is indicative of intervention efforts.
Data released Monday by the VA shows that 6,146 veterans took their own lives in 2020, 342 fewer deaths than 2019 and 650 fewer deaths than in 2018.
But a new analysis released Saturday by independent researchers shows the deaths may be significantly higher – a rate more than double the VA’s estimate when accounting for death certificate and records errors, accidental drug overdoses and unexplained deaths.
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The decline in the VA report, two years of improving numbers in a row, came amid concerns that the pandemic and related social isolation would negatively affect well-being, exacerbating mental health conditions and possibly leading to increased thoughts of suicide.
But the VA research noted no trends that would indicate an association between the early months of the pandemic and suicide.
"We did not see an increase in veteran suicide. We saw a decrease. So does that in of itself say no impact of COVID? No, it doesn't. What you can say is … there was a decrease within the first year of COVID," said Matthew Miller, the VA's national director of suicide prevention in the office of mental health and suicide prevention, speaking to reporters during a roundtable Friday.
The rate for suicide among veterans, when adjusted for age and gender, remained more than double the rate of non-veteran adults in the U.S. in 2020, but the adjusted rate showed a larger drop than the rate for the general population -- a 9.7% decline from 2018 compared with a 5.5% drop in the general population.
For its annual suicide report, the VA relies on data from the Centers for Disease Control and Prevention and the Department of Defense, which is subject to change depending on death certificates and additional data obtained after year's end.
The new report does not include the exact total number of deaths in 2019; last year, the VA reported that the department had 6,261 deaths by suicide in 2019, a decline of nearly 7% from 2018.
But a revised 2019 number of 6,489, obtained from the VA on Monday by request, shows the decline from 2018 to 2019 was closer to 4.5%.
Together with the estimated 5.4% decrease from 2019 to 2020, officials say the downward trend is encouraging.
"We know that suicide is preventable, and we at VA are well positioned to address this urgent and serious matter," said Dr. Tamara Campbell, acting executive director for the VA's office of Mental Health and Suicide Prevention, speaking to reporters during a roundtable Friday.
However, an independent study released Saturday takes issue with the numbers in the VA's annual suicide report, arguing that the suicide rate is much higher. In a preliminary report on an eight-year study dubbed "Operation Deep Dive," researchers from the America's Warrior Partnership, a suicide prevention group; Duke University; and the University of Alabama found that former service members took their own lives each year at a 34% higher rate than reported by the VA.
The researchers based their findings on death information from counties in eight states: Alabama, Florida, Maine, Massachusetts, Michigan, Minnesota, Montana and Oregon.
According to the VA report for 2020, an average 16.8 veterans died by suicide a day, down from almost 19 in 2018. The still-repeated mantra of "22 veteran suicides per day," from a decade ago was based on an extrapolation of data from 21 states, taken between 1999 and 2010.
Building out their analyses to a national level, however, the researchers for America’s Warrior Partnership estimated that roughly 24 veterans die by suicide each day, while another 20 veterans succumb to injuries such as accidents, accidental overdoses or undetermined causes.
"What we see is the trend hasn't gone down," said retired Air Force Lt. Col. Jim Lorraine, president of America's Warrior Partnership, during an interview with Military.com.
The study found that those most at risk for suicide were those who lived alone, resided in rural or suburban areas, served for less than three years or received a demotion while serving.
"If we can identify those at greatest risk at the county level, if the population is big enough, we can begin building a prevention strategy around those that are at greatest risk," Lorraine said. "One of the things we advocate for is a community-based approach [to preventing suicide]. It can't be a top-down approach. It has got to be a bottom-up approach."
VA officials maintain that their suicide data is accurate, based on verified data from the CDC and Defense Department, and the annual National Suicide Prevention Report tries to capture every veteran suicide for the year.
"Ending Veteran suicide and saving lives is our top clinical priority at VA, and we take every step possible to make sure that our Veteran suicide data is accurate -- because the first step to solving this problem is understanding it," VA Press Secretary Terrence Hayes said in an email Monday in response to the America’s Warrior Partnership report.
"The bottom line is this: One Veteran suicide is one too many, and VA will continue to accurately measure Veteran suicide so we can end Veteran suicide," Hayes said.
Suicides were the 13th leading cause of deaths among veterans in 2020, and suicide was the second leading cause of death among veterans under age 45.
In 2020, suicides among female veterans continued a downward trend, with the age-adjusted rate falling by 14.1%, a drop just slightly smaller than the 15% decline from 2018 to 2019. In contrast, suicides among male veterans dropped by .7%.
On a national level, suicides fell among non-veteran males by 2.1% and by 8.4% for non-veteran women.
Firearms continue to be the leading cause of death by suicide, with more than 70% of male and 48% of female veterans completing suicides with a weapon. However, Miller pointed out, use of firearms decreased in 2020 by 2.5% from the previous year, although it remains 4.5% higher from 2002, when the VA relied on data from fewer than half the states that reported their statistics to the CDC.
"I see that the VA, in collaboration with the community and other federal agencies, is making a difference," Miller said. "What you are seeing in 2019 and 2020 was Year 1 of our implementation of our strategic plan that entailed the deployment of clinically based and community-based interventions and approaches across the nation."
"We see signs of encouragement in the last two years," Miller added.
VA officials often say that veterans do better physically and mentally when they are part of the department's health system and have encouraged eligible veterans to seek VA services.
The VA report noted, however, that veterans in the VA health system had a suicide rate of 34.1 per 100,000, while those who were not in VA care had a rate of 23.8 per 100,000.
Miller said the reason for this difference is that the VA cares for patients with a complex set of medical conditions and circumstances -- more so than veterans who don't seek medical care.
"Would you expect to see a higher rate of heart attacks in the emergency room or in the flu clinic?" Miller said. "You take the same sort of underlying principles and dynamics, and with this population that we are honored to serve, there is the greater statistical likelihood of these sorts of issues and possible outcomes.”
To further reduce suicides among veterans, the VA launched a program that provides funding to community suicide prevention efforts, the Staff Sgt. Parker Gordon Fox Suicide Prevention Grant Program.
The VA also launched a competition in May to encourage organizations and communities to bring their prevention ideas to the department. Dubbed Mission Daybreak, the VA announced 30 finalists Monday who will receive $250,000 each and move ahead in the competition.
Ten additional teams earned awards of $100,000.
"Suicide is one of the most serious public health issues facing our Veterans today, and VA cannot do this work alone," VA Under Secretary for Health Dr. Shereef Elnahal said Monday in a press statement. "With the Staff Sergeant Fox Grants and Mission Daybreak, VA seeks to engage not only organizations traditionally focused on suicide prevention, but also to bring in new groups and individuals who may have fresh ideas on how we address this issue."
The full 2020 VA National Suicide Prevention report is available on the department's web site.
Veterans and service members experiencing a mental health emergency can contact the Veteran Crisis Line at 988, Press 1. They also can text 838255 or chat online at VeteransCrisisLine.net.
– Patricia Kime can be reached at Patricia.Kime@military.com. Follow her on Twitter @patriciakime.