Introduction

Veterans are killing themselves at more than double the rate of the civilian population with about 49,000 taking their own lives between 2005 and 2011, according to data collected over eight months by News21.

Records from 48 states show the annual suicide rate among veterans is about 30 for every 100,000 of the population, compared to a civilian rate of about 14 per 100,000. The suicide rate among veterans increased an average 2.6 percent a year from 2005 to 2011, or more than double that of the 1.1 percent civilian rate, according to News21’s analysis of states’ mortality data.

Nearly one in every five suicides nationally is a veteran — 18 to 20 percent annually — compared with Census data that shows veterans make up about 10 percent of the U.S. adult population.

“Anytime a veteran who fought our enemies abroad or helped defend America from within our borders dies by their own hand, it’s completely unacceptable,” Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veteran’s Affairs, told an American Legion conference in Washington earlier this year. The suicide rate has remained consistently high, he said, adding that more work was needed to address gaps in veterans’ mental health care.

“It’s not enough that the veteran suicide problem isn’t getting worse,” he said, “it isn’t getting any better.”

A 2007 law required the Department of Veterans Affairs to increase its suicide prevention efforts. In response to the Joshua Omvig Veteran Suicide Prevention Act — named for an Iraq war veteran who committed suicide in 2005 — the department’s efforts include educating the public about suicide risk factors, providing additional mental health resources for veterans and tracking veteran suicides in each state. The VA’s mental health care staff and budget have grown by nearly 40 percent over the last six years and more veterans are seeking mental health treatment.

The law mandated that the VA design a comprehensive program to reduce veteran suicides. Provisions included training VA staff in suicide-prevention techniques, factoring mental health concerns in overall veteran health assessments, providing referrals at veterans’ request to treatment programs and designating suicide-prevention counselors at VA medical centers. It also required the VA to work with the other federal departments on researching the “best practices” for preventing suicides.

VA efforts since 2007 have shown some results. The Veterans Crisis Line — a national phone line — has experienced a steady increase in the number of calls, texts and chat session visits from former soldiers struggling with suicidal thoughts. In 2007, its first year, 9,379 calls went to the crisis line. Each year the call volume has increased, reaching a high of 193,507 calls in 2012, totaling about 840,000 overall, according to the VA.

“It’s discouraging to keep looking at the (suicide) rates, and we have to keep plugging away,” said Dr. Jan Kemp, the VA national suicide-prevention coordinator, and program manager of the crisis line. But she said without resources such as the crisis line “the rates would be higher.”

The VA is analyzing mortality data collected from states and Department of Defense records to try to understand veteran suicides. The task has been “almost impossible” until recent years, Kemp said, because the federal Centers for Disease Control and Prevention does not track veteran deaths and most veterans are not enrolled in the VA system.

News21 sought data on post-9/11 veteran suicides, but state statistics rarely included identifying information or detailed service records. However, a 2012 report from Substance Abuse and Mental Health Services Administration (SAMHSA) showed that between 2002 and 2005, 144 veterans of post-9/11 wars committed suicide out of total veteran population of 490,346. In 2009, 98 men and women from post-9/11 wars took their own lives, according to that same report.

A plurality of veteran suicides has been among those 65 or older, according to the data. About 19 percent of suicides that took place between 2005 and 2011 were veterans between 18 and 44 years old, among the 36 states with available age data. It is important to reach post-9/11 veterans early, Kemp said, to help mitigate a potential increase in suicides as veterans approach those vulnerable ages.

“Maybe we can change that trajectory,” she said.

War can exact a heavy toll on the mental health of soldiers, but veterans have the same risk factors for suicide as the general population, said Craig Bryan, research director at the University of Utah National Center for Veterans Studies. Those factors include feelings of depression, hopelessness, post-traumatic stress disorder, a history of trauma and access to firearms.

“Veterans who die by suicide look a lot like Americans who die by suicide,” Kemp said.

Veterans experience periods of readjustment as they reintegrate into civilian life. Traits and training needed to survive in a war zone — like maintaining constant alertness — might contribute to troubling behaviors in civilian life, including edgy feelings while being easily startled, according to the SAMHSA report. Suicide warning signs including feelings of being hopeless, out of control, angry or trapped. Combat veterans might experience a variety of stress reactions including nightmares, sleeplessness, sadness, feelings of rejection, abandonment or hopelessness. Lack of concentration, aggressive behavior, reckless driving, and increasing use of alcohol, tobacco and drugs are other common struggles.

Clinton Hall, 35, lives in Portland, Ore., working as a supply-chain analyst. He served in Iraq and Afghanistan as an Army specialist and was discharged in 2007. One of his close friends, who also was a veteran, committed suicide upon coming home.

“The bad part about it is that he didn’t give us a chance to talk. I mean, if he had just said, ‘Hey, Clint I’m thinking about doing this.’ I could have said, hey man, I’m thinking about doing it too. You got to have that conversation. You have to tell somebody, as embarrassing as it is,” he said. “All I ever considered when I thought about (suicide) was the guilt I was feeling and just wanting a way out, wanting to not have those memories anymore.”

Concussions also are a chronic risk factor leading to suicidal thoughts, Bryan said, because head trauma makes people more vulnerable to suicidal thoughts. The dangerous daily routines of a soldier — or simply involvement in sports or accidents — increase the risk of injury.

“It turns up the volume on depression,” he said.

In 2010, Veterans Affairs Secretary Eric Shinseki asked governors to collaborate on collecting veterans’ suicides information in their states. Through November 2012, according the VA report, 34 states had submitted data and agreements had been forged with eight others to provide information.

News21 filed a Freedom of Information Act request for the raw data collected by the VA to this point, but it was denied because the “disclosure of raw research data poses a serious threat to the scientific process” and because of fears the information would be misinterpreted without peer review.

Most states provided veteran suicide information gleaned from death certificates. VA research, Kemp said, shows death certificates are about 90 percent accurate and “good enough” to help understand veteran suicides.

Veterans are over-represented among suicides compared to the general population, a trend seen in most states between 2005 and 2011.

For example, in Alaska, veterans were about 14 percent of the population, but represented about 21 percent of all suicides in 2010. The same year in Washington, Census data showed veterans were about 11 percent of the population, but state vital statistics showed they represented about 23 percent of suicides.

Suicide rates within the veteran population often were double and sometimes triple the civilian suicide rate in several states. Arizona’s 2011 veteran suicide rate was 43.9 per 100,000 people, nearly tripling the civilian suicide rate of 14.4, according to the latest numbers from the state health department.

Among states with the widest disparities and highest rates, Idaho had an average annual veteran suicide rate of 49.5 per 100,000 people, according to News21 analysis, compared to a civilian rate of 20 per 100,000. Montana had an average annual veteran suicide rate of 55.9 per 100,000 people and a 23.9 civilian rate.

New Jersey had among the lowest annual veteran suicide rates across the time period, with 17.2 dying by suicide per 100,000 people and a civilian rate of 8.6 Connecticut had a veteran suicide rate of 20.11 per 100,000 people and a civilian rate of 11.

Massachusetts had the smallest disparity and one of the lowest rates, according to the data, with an average annual veteran suicide rate of 12.3 and a civilian rate of 10.3.

About 26 percent of suicides in Oregon were among veterans, with 96 percent of them being male, according to a November 2012 study by the state’s human services department. New21 analysis showed that 24 percent of all Oregon suicides annually were veterans.

As with suicides in general, veterans taking their own lives have been overwhelmingly male — about 97 percent among the 30 states that reported gender demographics. While suicide has traditionally been a problem among white males, it underscores the suicide risks faced by the U.S. veteran population.

In June, the VA hired 1,600 clinicians to assist with mental health counseling for veterans in compliance an executive order last year from President Barack Obama. This is only part of the solution, Utah researcher Bryan said, because “veterans don’t come to mental health treatment.”

The challenge is understanding suicide in the general population, Bryan said, and then translating those factors for the military and veterans, who are part of a “unique subculture” in the U.S.

“(Veterans) have different rules and different expectations and ways of seeing themselves” and their roles in society, he said. “What we see in society doesn’t always translate as well into the military.”

Part of that culture is mental toughness, he said, along with “elitism” and “feelings of superiority,” mindsets that render traditional suicide prevention methods less effective. “They are very much like elite athletes,” he said of those least likely to complain of pain or injury.

Hall, who was diagnosed with PTSD following his return home, had a message for veterans who might struggle — as he did — with suicidal thoughts:

“Talk to anybody. If you’ve got a number or an email address for your battle buddies, reach out to them. Chances are, they’re feeling the same way you do. If you don’t have anybody to talk to, call the VA. Call the suicide prevention hotline. Hell, if you can find me on Google, contact me and we’ll talk. But don’t do it (commit suicide). I’m thinking about it too, I know other people are too. But don’t do it.”

The Veterans Crisis Line can be reached online or by calling 800-273-8255.

Bonnie Campo and and Chase Cook were Ethics and Excellence in Journalism Foundation Fellows for News21 this summer.