U.S. veterans are suffering from mental illness at an alarming rate

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Veterans are suffering from mental illness at an alarming rate with young, male veterans most at risk

While the suicide rate among veterans has gone down, it’s still significantly higher than the general population.

Veterans are suffering from mental illness at an alarming rate with young, male veterans most at risk
THE NEWS

At the 11th hour of the 11th day of the 11th month of 1918, a ceasefire was called between the Allied Forces and Germany. That’s the origin of the Nov. 11 date for Veterans Day. It was then called Armistice Day, and President Woodrow Wilson declared it a time to honor those who died in what was called the “war to end all wars.”

World War I wasn’t the last war; millions of Americans have served in many wars since. But it did mark the beginning of a recognition that soldiers were returning home from battle with debilitating symptoms that weren’t only physical but psychological as well.

Soldiers had coined the term “shell shock” for a condition that caused a range of symptoms, from shaking, headaches, dizziness, confusion, memory loss and sleep disorders. Doctors thought the condition may be caused by proximity to an explosion, but soon they discovered that some soldiers presented with the same symptoms who were not near explosives.

While treatment for trauma has come a long way, soldiers who return home suffering from PTSD, anxiety, depression and other mental health conditions remains alarmingly high a century later.

THE CONTEXT

A snapshot of the most recent data shows the veteran suicide rate is down from 2020, but it has generally been on the rise since 2011 and is still significantly higher than the rate for the general population. The percentage of veterans with post-traumatic stress disorder and other mental health issues is also higher than that of the rest of the United States.

While there has been a consistent flow of legislation over the past 25 years to support veterans who need mental health support, experts say there is quite a bit that still needs to be done to “plug the holes” where support is lacking. Most of it is about easing the restrictions on the kind of mental health support veterans can access and where.

HEALTH LENS

More tours of duty may increase the risk of mental health issues

As a group, veterans have significantly higher rates of some mental illnesses than nonveterans, a reflection of the enduring physical and psychological traumas of war.

One of the biggest problems is post-traumatic stress disorder, which affects approximately 11 to 20 percent of veterans in a given year, according to the Department of Veterans Affairs. That’s starkly more than the 6 percent of the U.S. population who will experience PTSD at some point in their lives. Veterans living with PTSD often relive traumatic events in painfully real detail, leading to a state of hyperarousal.

That stress can spillover into all aspects of their life, impairing sleep, interfering with concentration, and harming relationships with friends and family.

PTSD is especially common after deployment, but rates vary among wars, impacting as many as:

Symptoms often emerge soon after returning to civilian life but can also resurface years or decades afterward. It’s not just PTSD either; veterans experience higher depression rates than civilians after deployment.

Repeated tours of duty may increase the risk of developing mental health problems. Marines who were deployed to Iraq twice instead of once had double the risk of developing PTSD, though other studies find no correlation.

The physical harms of war can affect mental health too. Traumatic brain injuries (TBI), sustained from blasts or other blows, can double the risk of developing PTSD, studies suggest. TBIs can also cloud concentration, cause sleep problems and lead to chronic pain. While many recover from such injuries, a good chunk of the more than 450,000 veterans diagnosed with a TBI since 2000 live with lingering effects. And repeated blows or jolts can compound problems — veterans with multiple TBIs were about twice as likely to report suicidal thoughts than veterans who’d experienced one or no TBI.

Combat is not the only military experience that can lead to mental illness. Sexual assault rates are higher in the military than civilian populations, especially among female service members. Among veterans who use Veterans Affairs healthcare, 23 percent of women reported sexual assault while in the military, and over half experienced sexual harassment. Such experiences can contribute to PTSD as much, and in some cases more than, combat exposure.

These combined mental health impacts of service may have physical effects. Research suggests that veterans have higher risk of cardiovascular disease, high blood pressure, some forms of cancer, chronic pain and stroke than nonveterans.

Altogether, the psychological and physical toll of military service likely contributes to the higher suicide rates among veterans. Veterans are nearly twice as likely to die by suicide than nonveterans, according to federal estimates, though the burden may be even higher. One recent study suggests about 44 veterans die a day by suicide, more than twice the official estimate.

— Jonathan Lambert

DATA LENS

Those most at risk for suicide: young, male veterans

While suicide is a leading cause of death in the U.S., suicides for veterans is 57.3 percent higher than it is for nonveterans, adjusting for age and sex, according to Congressional Research Service analysis of Veteran Affairs data.

Male veterans were at the highest risk for suicide; in 2019, that demographic saw rates of 34.5 deaths per 100,000 people, compared with 17.1 deaths for female veterans, according to the data appendix accompanying the VA’s annual report on veteran suicide prevention.

Age was also a factor: Younger veterans, who include veterans who’ve more recently transitioned to civilian life, generally have higher rates of suicide than other age groups, at more than 50 deaths per 100,000 people annually.

There has been a promising trend downward in suicide rates starting in 2019, with a 7 percent decrease in the adjusted suicide rate — or 399 fewer deaths than the year before.

That has public health experts breathing a sigh of relief. Going into the pandemic, many experts feared an uptick in suicidal behavior, but, as of last year, that appears to not be the case. Veteran suicide rates followed the same pattern as the general public in that first year of the pandemic — they declined.

A study published in JAMA Psychiatry last year also found that rates of suicidal thoughts and attempts among veterans didn’t increase when the pandemic started. One of several possible reasons for this was that veterans felt covid fostered a stronger support system.

Veterans who reported a decrease in suicidal thoughts may have been better able to get more support during the pandemic by using virtual technology like FaceTime or Zoom, Brandon Nichter, the study’s lead author, told Bill Hathaway for Yale News.

Despite this, the study also found that about 2.6 percent of veterans (that’s more than 475,000 people) developed new-onset suicidal ideation during the pandemic.

“These individuals tended to have a history of mental illness including post-traumatic stress disorder, substance use problems, or a history of past suicide attempts,” Hathaway wrote. Veterans who’d previously been infected with covid were more than twice as likely to report suicidal ideation in the past year.

Anna Deen

POLICY LENS

Democrats and Republicans are generally aligned when it comes to veteran mental health support

There has been quite a bit of bipartisan legislation to improve services for veterans with mental health issues, with some notable success, said a House Veterans Affairs Committee staffer, noting the lower suicide rate among veterans in 2020 (the most recent data).

“Still,” the staffer told Grid, “no one is taking a victory lap when even one veteran dies by suicide or struggling with mental health — there is so much more to do to help veterans thrive.”

The most recent legislation to make it through includes:

  • Sgt. Ketchum Rural Veterans Mental Health Act, which provides more access to mental health services for veterans in rural areas
  • Solid Start Act, which makes permanent a new VA program to proactively reach out to new veterans during the stressful first year after separation from active duty
  • Commander John Scott Hannon Veterans Mental Health Care Improvement Act, which increased VA mental healthcare services and research
  • Veterans’ COMPACT Act, which will make emergency suicidal stabilization care free for veterans in crisis wherever they seek help.

The committee staffer said she has been pleased with how much both parties in the House and Senate Committees on Veterans Affairs are on the same page when it comes to veteran mental health legislation. And they are definitely aligned on looking at mental health as part of a larger “veteran health portfolio” that includes housing, jobs and support when transitioning to civilian life.

But, she adds, while they all have the same goal, sometimes they differ on how to get there.

“One example: safer storage of firearms. We know that putting time and distance between someone in crisis and firearms could lower the suicide rate tomorrow. We have legislation to expand what the VA is doing to promote safe storage of firearms in the veteran community. But we don’t have the support of colleagues across the aisle on those efforts.”

As for whether any other legislation on veteran mental health will make it into law this year, a legislative associate with the American Legion, an organization that lobbies for veterans’ rights, said it’s a strong maybe, but there’s a lot of competition to get anything on the floor for a vote these days.

Suzette Lohmeyer

IF YOU NEED HELP

If you are a veteran who needs help or know of one who does, the Department of Veterans Affairs has a number of resources listed here.

Thanks to Lillian Barkley for copy editing this article.

  • Jonathan Lambert
    Jonathan Lambert

    Public Health Reporter

    Jonathan Lambert is a public health reporter for Grid focused on how science, policy and the environment shape our collective well-being.

  • Anna Deen
    Anna Deen

    Data Visualization Reporter

    Anna Deen is a data visualization reporter at Grid.

  • Suzette Lohmeyer
    Suzette Lohmeyer

    Senior Editor

    Suzette Lohmeyer is the senior editor at Grid, where she focuses on daily news.

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