At No Fallen Heroes we are dedicated to the reduction and elimination of veteran suicide. Thus, we are concerned about a range of mental health issues affecting veterans. Some of these issues may pre-exist military service. How does mental health prior to military service affect those on active duty and how often do such issues remain throughout military service and into life as a veteran? How do such issues affect the incidence of suicide?
Prior Mental Health and Suicide Attempts During Active Duty
The Journal of the American Medical Association (JAMA) published a study in 2022 of suicide attempts during military service and pre-enlistment mental health status. The study looked at suicide attempts among a cohort of 21,772 regular army enlisted soldiers and compared those who did and those who did not have a history of mental health problems prior to enlistment. They concluded that pre-enlistment mental health status has a bearing on the likelihood of suicide attempts by active duty enlisted personnel.
Suicide and Mental Health Study Results
In the study 253 soldiers out of 21,772 attempted suicide within their first 48 months of active service. The incidence of suicide attempts peaked just before the end of the first year in service and was no different for those who did or did not receive a mental health diagnosis during their time in service. The one factor that predicted more suicide attempts was a pre-service history of mental health disorders. The timing of suicide attempts was no different between those with a prior mental health diagnosis and those without one. While some did not have a prior diagnosis of mental health issues, these soldiers still reported suicidal ideation prior to their attempts. The overall risk of a suicide attempt was 1.6% in those with a mental health diagnosis and 1% in those without.
Mental Health Issues Prior to Military Service
According to the authors of the study, just under 40% of soldiers had a pre-enlistment history of mental health issues. One in seven reported pre-enlistment suicidal ideation and one in fifty reported a suicide attempt. In general, repeated thoughts of self-injury are related to an increased risk of suicide attempts both in those with a prior mental health diagnosis and those without. The researchers found no relationships with gender or ethnicity in comparing suicide attempts in those with and without a prior diagnosis of mental health issues.
Timing of Suicide Risk
Something that stood out for us when we read the study was that suicide attempts peaked near the end of the first year in service. This is a time when the soldier is still adapting. We also know that in the first year after military discharge the rate of suicide rises as the veteran adapts to civilian life. Part of this in both cases is that the soldier or veteran is confronted with new challenges and part is because the soldier or veteran needs to adapt to these new circumstances whether they have a prior history of mental health issues or not.
Why Do Veterans Have a Higher Suicide Risk?
Over several decades active duty personnel had a lower risk of suicide attempts than society at large but that changed during the War on Terror and now is about the same. However, the risk of suicides in veterans has risen to one and a half times that of the civilian population . The higher exposure to trauma, isolation, loneliness, burnout, stress, and difficulties reintegrating into civilian life all contribute to the higher rate of veteran suicide. In both active duty personnel and veterans the peak times for suicide attempts is during the first year of a transition.
By recognizing those soldiers and veterans with pre-existent mental heath issues it may be possible to intervene and prevent some suicide attempts. By recognizing risk factors like PTSD, traumatic brain syndrome, depression, and substance abuse disorders more suicides may be prevented. By getting treatment with appropriate psychedelic medicines research has shown that these conditions can be greatly improved or eliminated and the risk of suicide substantially reduced. A major factor in all of this is the recognition of those soldiers and veterans with mental health issues that may go back before they even started military service.