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Original Research Focus on Suicide April 13, 2026

Suicide Risk and Veterans Health Administration Utilization Among those With a Documented Suicide Attempt in the US Military

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J Clin Psychiatry 2026;87(2):25m16168

Abstract

Objective: To examine how Veterans Health Administration (VHA) utilization and suicide outcomes differ for those with and without a suicide attempt prior to separating from the military.

Background: Suicide attempts are frequently described as an important risk factor for future suicide behaviors. Additionally, Veterans who have recently transitioned out of military service have been identified as an at-risk group. We evaluated whether a suicide attempt prior to transition out of military service is an important risk factor among US Veterans.

Methods: This retrospective study included 1,030,599 service members who separated from the active US military from 2015 to 2020. VHA utilization, VHA documented suicide behaviors, suicide mortality, and all-cause mortality in the 2 years following separation were examined, comparing those with and without a documented suicide attempt in their last 2 years of active duty service.

Results: Service members with a documented suicide attempt prior to military separation were significantly more likely to initiate VHA care (hazard ratio [HR]=1.91 [95% CI, 1.84–1.98]) and VHA mental health care (HR =2.20 [95% CI, 2.13–2.28]) compared with those without an attempt. Among those who initiated VHA care, 90% of those with a recent military suicide attempt accessed VHA mental health services. Still, 39% of those with a suicide attempt prior to separation did not utilize VHA care. Those with a history of suicide attempt prior to transition were also more likely to have a suicide attempt (relative risk=7.78 [95% CI, 7.10–8.52]) or die from suicide (standardized mortality ratio= 9.94 [95% CI, 7.37–13.10]) after separation than those without.

Conclusions: Results indicate that most Veterans in this group receive VHA services after separation, but a significant minority of high-risk Veterans remain unengaged.

J Clin Psychiatry 2026;87(2):25m16168

Author affiliations are listed at the end of this article.

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  1. Eaton KM, Messer SC, Garvey Wilson AL, et al. Strengthening the validity of population-based suicide rate comparisons: an illustration using US military and civilian data. Suicide Life Threat Behav. 2006;36(2):182–191. PubMed CrossRef
  2. Reger MA, Reger GM, Krieg C, et al. What’s changed? A comparison of Army suicide surveillance data to cases from 1975 to 1982. Suicide Life Threat Behav. 2018;48(1):21–30. PubMed CrossRef
  3. Hoge CW, Ivany CG, Schoenbaum M. Death by suicide in US military during the Afghanistan and Iraq wars. Lancet Psychiatry. 2016;3(11):1001–1003. PubMed CrossRef
  4. U.S. Department of Defense, Office of the Under Secretary of Defense for Personnel and Readiness. Calendar Year 2023 Annual Report on Suicide in the Military; Including the Department of Defense Suicide Event Report (DoDSER). 2024. https://www.dspo.mil/Portals/113/2024/documents/annual_report/ARSM_CY23_final_508c.pdf. Accessed September 24, 2025
  5. U.S. Department of Veterans Affairs, Office of Suicide Prevention. 2024 National Veteran Suicide Prevention Annual Report, part 2 of 2: report findings. 2024. https://www.mentalhealth.va.gov/docs/data-sheets/2024/2024-Annual-Report-Part-2-of-2_508.pdf. Accessed September 24, 2025
  6. U.S. Department of Veterans Affairs, Office of Suicide Prevention. 2024. 2024 National Veteran Suicide Prevention Annual Report, Part 1 of 2: In-depth Reviews. https://www.mentalhealth.va.gov/docs/data-sheets/2024/2024-Annual-Report-Part-2-of-2_508.pdf. Accessed September 23, 2025
  7. Reger MA, Smolenski DJ, Skopp NA, et al. Risk of suicide among US military service members following Operation Enduring Freedom or Operation Iraqi Freedom deployment and separation from the US military. JAMA Psychiatry. 2015;72(6):561–569. PubMed CrossRef
  8. Shen YC, Cunha JM, Williams TV. Time-varying associations of suicide with deployments, mental health conditions, and stressful life events among current and former US military personnel: a retrospective multivariate analysis. Lancet Psychiatry. 2016;3(11):1039–1048. PubMed CrossRef
  9. Kapur N, While D, Blatchley N, et al. Suicide after leaving the UK armed forces-a cohort study. PLoS Med. 2009;6(3):e26. PubMed CrossRef
  10. Ravindran C, Morley SW, Stephens BM, et al. Association of suicide risk with transition to civilian life among US military service members. JAMA Netw Open. 2020;3(9):e2016261. PubMed CrossRef
  11. Order No. 13822, Presidential Executive Order on Supporting Our Veterans During Their Transition From Uniformed Service to Civilian Life: Executive Order 13822. White House. 2018. https://www.federalregister.gov/documents/2018/01/12/2018-00630/supporting-our-veterans-during-their-transition-from-uniformed-service-to-civilian-life. Accessed July 11, 2025
  12. U.S. Department of Veterans Affairs, Office of Mental Health and Suicide Prevention. National Strategy for Preventing Veteran Suicide 2018-2028. 2018. Accessed September 24, 2025. https://www.mentalhealth.va.gov/suicide_prevention/docs/Office-of-Mental-Health-and-Suicide-Prevention-National-Strategy-for-Preventing-Veterans-Suicide.pdf
  13. Bostwick JM, Pabbati C, Geske JR, et al. Suicide attempt as a risk factor for completed suicide: even more lethal than we knew. Am J Psychiatry. 2016;173(11):1094–1100. PubMed CrossRef
  14. Harris EC, Barraclough B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry. 1997;170:205–228. PubMed CrossRef
  15. Hein TC, Cooper SA, McCarthy JF. Mortality following non-fatal suicide attempts by Veterans in Veterans Health Administration care. Suicide Life Threat Behav. 2022;52(2):222–230. PubMed CrossRef
  16. Geulayov G, Casey D, Bale L, et al. Suicide following presentation to hospital for non-fatal self-harm in the Multicentre Study of Self-Harm: a long-term follow-up study. Lancet Psychiatry. 2019;6(12):1021–1030. doi:10.1016/S2215-0366(19)30402-X. PubMed CrossRef
  17. Bryan CJ, Bryan AO, Ray-Sannerud BN, et al. Suicide attempts before joining the military increase risk for suicide attempts and severity of suicidal ideation among military personnel and veterans. Compr Psychiatry. 2014;55(3):534–541. PubMed CrossRef
  18. Straud CL, Moore BA, Hale WJ, et al. Demographic and occupational risk factors associated with suicide-related aeromedical evacuation among deployed U.S. military service members. Mil Med. 2020;185(11-12):e1968–e1976. PubMed CrossRef
  19. Marini M, Gutkind S, Livne O, et al. Mental health treatment among U.S. military veterans: insights from the National Health Interview Survey. J Gen Intern Med. 2025;40(11):2723–2731. PubMed CrossRef
  20. Stene-Larsen K, Reneflot A. Contact with primary and mental health care prior to suicide: a systematic review of the literature from 2000 to 2017. Scand J Public Health. 2019;47(1):9–17. doi:10.1177/1403494817746274. PubMedCrossRef
  21. Stanley IH, Chu C, Gildea SM, et al. Predicting suicide attempts among U.S. Army soldiers after leaving active duty using information available before leaving active duty: results from the Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study (STARRS-LS). Mol Psychiatry. 2022;27(3):1631–1639. PubMed CrossRef
  22. Gahm GA, Reger MA, Kinn JT, et al. Addressing the surveillance goal in the national strategy for suicide prevention: the Department of Defense Suicide Event Report. Am J Public Health. 2012;102(Suppl 1):S24–S28. PubMed CrossRef
  23. Mash HBH, Ursano RJ, Kessler RC, et al. Predictors of suicide attempt within 30 days of first medically documented major depression diagnosis in U.S. army soldiers with no prior suicidal ideation. BMC Psychiatry. 2023;23(1):392. PubMed CrossRef
  24. Mash HBH, Ursano RJ, Kessler RC, et al. Predictors of suicide attempt within 30 days after first medically documented suicidal ideation in U.S. army soldiers. Am J Psychiatry. 2021;178(11):1050–1059. PubMed CrossRef
  25. Zuromski KL, Bernecker SL, Gutierrez PM, et al. Assessment of a risk index for suicide attempts among US army soldiers with suicide ideation: analysis of data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). JAMA Netw Open. 2019;2(3):e190766. PubMed CrossRef
  26. U.S. Department of Veterans Affairs. Suicide Prevention Program (VHA Directive 1166 Appendix B). Accessed September 24, 2025. https://www.va.gov/vhapublications/publications.cfm?pub=1
  27. U.S. Department of Veterans Affairs. Suicide Prevention Program (VHA Directive 1160.07). Accessed September 24, 2025. https://www.va.gov/vhapublications/publications.cfm?pub=1
  28. Hoffmire C, Stephens B, Morley S, et al. VA Suicide Prevention Applications Network: a national health care system-based suicide event tracking system. Public Health Rep. 2016;131(6):816–821. PubMed CrossRef
  29. U.S. Department of Veterans Affairs, Office of Suicide Prevention. Joint Department of Veterans Affairs and Department of Defense Mortality Data Repository. Data set compiled from the National Death Index. 2024.
  30. Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–706. PubMed CrossRef
  31. Estimating a relative risk (also called risk ratio, prevalence ratio). SAS Institute Inc; 2022. Accessed September 24, 2025. https://support.sas.com/kb/23/003.html
  32. U.S. Department of Veterans Affairs. Office of Research and Development. Program Guide: 1200.21 VHA Operations Activities That May Constitute Research. 2019. https://www.research.va.gov/resources/policies/ProgramGuide-1200-21-VHA-Operations-Activities.pdf. Accessed September 24, 2025
  33. Fink DS, Stohl M, Mannes ZL, et al. Comparing mental and physical health of U.S. veterans by VA healthcare use: implications for generalizability of research in the VA electronic health records. BMC Health Serv Res. 2022;22(1):1500. PubMed CrossRef
  34. Susukida R, Mojtabai R, Mendelson T. Sex differences in help seeking for mood and anxiety disorders in the National Comorbidity Survey-Replication. Depress Anxiety. 2015;32(11):853–860. PubMed CrossRef
  35. Adams K. Veteran suicide statistics are horrifying — what is the VA doing to help?. MedCity News. 2024. https://medcitynews.com/2024/02/veteran-suicide-healthcare/. Accessed September 24, 2025
  36. Sultan S, Linskens E, Gustavson A, et al. Systematic Review: Population and Community-based Interventions to Prevent Suicide. Department of Veterans Affairs (US); 2021. Accessed April 2, 2026. https://www.hsrd.research.va.gov/publications/esp/suicide-prevention-REPORT.pdf.
  37. Mackowiak C, Eagan AE, Gerstel-Santucci CM, et al. Expanding veteran suicide prevention: the role of community engagement and partnership coordinators. Psychol Serv. 2025;23(1):85–90. PubMed CrossRef

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