Following two straight years of decline in the number of veterans who died by suicide, self-inflicted deaths among veterans rose by 1.8% in 2021, with 6,392 veterans dying in the first full year of the pandemic, according to the Department of Veterans Affairs' annual suicide prevention report, released Thursday.
The rise coincided with an increase in suicides across the U.S.. In 2021, suicides were up by 4% for a total of 40,020 persons, according to the Centers for Disease Control and Prevention. But when comparing similar demographics by age and gender, the rate of veteran of veterans suicide increased by 11.6%, more than twice the increase of 4.5% among non-veteran U.S. adults.
The increase is disheartening for VA officials following two years of declines, given that the department has implemented numerous programs and services over the past several years to prevent suicide and broaden access to mental health care.
"There is nothing more important to VA than preventing veteran suicide -- nothing," VA Secretary Denis McDonough said in a statement Thursday. "One veteran suicide will always be one too many, and we at VA will use every tool at our disposal to prevent these tragedies and save veterans' lives."
During a media roundtable Wednesday ahead of the report's release, VA Under Secretary for Health Dr. Shereef Elnahal said the VA has not pinpointed the exact reason for the increase but several factors, including the COVID-19 pandemic, likely contributed.
"[The pandemic] led to greater financial strain, housing instability, anxiety and depression levels and barriers to health care, all of which are associated with the increased risk of suicide," Elnahal said.
The 2023 Annual National Veteran Suicide Prevention Report focused on 2021, the most recent year for which data was available. According to the report, the number of suicides increased in 2021 by 114.
Overall, the suicide rate among U.S. veterans in 2021 was 33.9 per 100,000, compared with the U.S. non-veteran population of 16.7 per 100,000.
Subgroups such as female veterans, the homeless and those between the ages of 18 and 34 were hit particularly hard, according to the report.
The deaths included 6,042 suicides among male veterans and 350 among female veterans.
The adjusted rate of suicide among female veterans was nearly four times that of male veterans -- a 24.1% increase for women, compared with a 6.3% increase for males.
Matthew Miller, the VA's executive director of suicide prevention in the office of mental health and suicide prevention, said increased firearms sales nationwide during the pandemic may have played a role, with female veterans choosing weapons to complete a suicide. The suicide rate among female veterans using a firearm was 281% higher than non-veteran women.
"There may be a bit of a bias where we think that firearms are for discussion with male veterans," Miller said. "We're going to engage in a significant push across our clinics and facilities to increase firearm lethal mean safety discussion with women veterans this year and next."
Firearms continue to be the leading cause of death by suicide among all veterans, with 73% of male and nearly 52% of female veterans completing suicides with a weapon. According to Miller, the suicide rate among veterans using a firearm has increased by 58% since 2001.
"We have to think more expansively than just access to health care on this very important [prevention] mission," Elnahal said. "Our public health efforts -- to include, of course, messaging, but also our efforts around lethal means safety and handing out as many gun locks as possible is just one example -- are equally important in reducing veteran suicide."
Veterans who regularly receive VA health care also had higher rates of suicide, particularly homeless veterans and those involved in the justice system. Miller noted that veterans who get care in the VA system often have more complex physical and mental health conditions than those who don't seek treatment.
The report found suicide was the 13th-leading cause of death among all veterans in 2021 but the second-leading cause among veterans ages 18 to 34.
There was some good news among the data, however -- what the VA calls "Anchors of Hope."
The suicide rate fell by 8.1% for veteran men age 75 and older. It also dropped by 2.2% among all veterans ages 55 to 74 who receive care at the VA, and it declined by 1.9% among male veterans ages 18 to 34 who had used VA health care in the previous year.
The rate among young veterans who left the service in the previous year also dipped slightly, from a rate of 47.6 per 100,000 veterans from 48.9 per 100,000 veterans.
Among those transitioning, however, former Marines have consistently had the highest rates of suicide since 2015. Among those who separated in 2020, the Marine Corps rate was nearly 81 per 100,000, followed by the Navy and the Army. There were fewer than 10 suicides among Air Force and Space Force veterans.
Miller said programs such as the VA's Solid Start program, in which the VA contacts separated service members several times during their first year of transition to civilian life, began in early 2020 and is having "tremendous success."
He added that the VA should consider additional prevention outreach to young Marine Corps vets.
According to the VA report, the suicide rate translates into 17.5 deaths a day, still down from 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.
This year's data was drawn from veteran mortality statistics from every state, the District of Columbia, Puerto Rico and the territories, according to the report.
The previous report stated that 6,146 veterans died by suicide in 2020, a 5.3% decline from 2019. But the latest report included an updated figure for veterans suicides in 2020 of 6,278, meaning that veterans suicide actually dropped the previous year by a smaller percentage -- 3.25% -- than what was initially thought.
Miller said such changes to the numbers occur each year as a result of late or modified reports from the states to the Centers for Disease Control and Prevention.
Earlier this week, the ranking Republican on the Senate Veterans Affairs Committee, Sen. Jerry Moran of Kansas, requested a Government Accountability Office review of the VA's suicide hotline, known as the Veterans Crisis Line, after whistleblowers told him that callers that are considered difficult or demonstrate "disruptive behavior," such as cursing and raised voices, are handed over to a "callers with complex needs" unit that is understaffed and undertrained.
In September, the VA Office of Inspector General released an investigation into an incident at the Veterans Crisis Line that confirmed that a veteran who contacted the line died by suicide minutes after contact was dropped. The inquiry found that the Veterans Crisis Line responder failed to adhere to protocols for helping the troubled veteran.
According to the VA, it has hired more than 900 staff members to man the Veterans Crisis Line and has put in place nearly 1,000 responders since the 988 phone number was established last year.
On Wednesday, McDonough and Elnahal said they welcomed the GAO review and pledged to implement any recommendations.
"Our top priority with the VCL is to make sure that veterans get the support they need, whenever and wherever they need it -- and we will never settle for anything less," McDonough wrote in a letter to Moran released Wednesday.
"We appreciate when ... observations or concerns are raised, whether it be through a senator's office, whether it be through a whistleblower or other process," Elnahal told reporters. "We look forward to diving into the facts of that situation and responding accordingly."
As part of the report, VA officials renewed a pledge to combat suicide among veterans. They said they plan to continue promoting safe firearm storage among veterans, focus on continued collaboration with community groups to reach veterans who aren't engaged with the VA, increase access to mental health services and expand crisis intervention programs such as the Veterans Crisis Line and the COMPACT Act -- legislation that allows VA to cover health-care costs for veterans in a suicidal crisis, regardless of their enrollment with the VA.
According to Elnahal, 30,000 veterans have utilized that coverage since it was authorized earlier this year. The law allows VA to cover up to 90 days of outpatient care and inpatient psychiatric hospitalization for up to 30 days, either at a VA facility or in the community.
"Which means that many lives [were] potentially saved in the period immediately after a suicide attempt or crisis," Elnahal said.
Service members or veterans experiencing a mental health crisis or their loved ones can call the Veterans Crisis Line 24/7 at 988, Press 1. Help also is available online at VeteransCrisisLine.net/Chat, or by texting 838255.
-- Patricia Kime can be reached at Patricia.Kime@Military.com.