What’s New in Psychology

New Study Sheds Light on Which Veterans Like lot to Commit Suicide    

Jim Windell

           Although suicide was the 12th-leading cause of death for military veterans in 2022, it was the second-leading cause of death for veterans under the age of 45.

           According to a Veterans Administration study in 2024, there were 6,407 veteran suicide deaths in 2022, three more than in 2021. A vast majority of those suicides were males with only about five percent females.

           When compared to total suicides in the U.S., veterans were two and a half more likely to commit suicide than were other adults.

           And veterans were far more likely to kill themselves using a firearm, than were other U.S. adults.

           But which veterans have the highest risk of dying by suicide?

           That question was explored in a study by a team from the University of Michigan Medical School’s Department of Psychiatry, the VA Center for Clinical Management Research, and the VA Ann Arbor Healthcare System. The results of that study were recently reported in JAMA Network Open.

           The study focused on veterans who received a Comprehensive Suicide Risk Evaluation (CSRE) assessment from a VA clinician. The CSRE program launched nationally six years ago, and the new study looks at suicide deaths among veterans who received an assessment during its first year. The study examined suicide deaths both in the first 30 days and the first year after a CSRE.

           In all, there were 791 suicides following the 269,374 CSREs that were completed for 153,736 Veterans Health Administration patients between November 2019 and December 2020, the study finds. Of those, 144 suicides occurred within 30 days after a CSRE; the rest were within a year of the CSRE visit. While most of those who died by suicide after a CSRE had been classified as having an especially high risk of near-term or long-term suicide based on their answers on the CSRE scale, there were also suicide deaths among those who fell into the lower-risk category on their CSRE.

           “Suicide prediction has long been a challenge for the field, so this finding that some of the risk factors that are routinely assessed in the Veterans Health Administration predicted future risk of suicide is important,” says Kevin Saulnier, Ph.D., a psychologist who has performed CSREs as part of his practice at VA Ann Arbor’s mental health clinic. “While this study did not look at what treatments and supports patients received after their CSRE, it can immediately inform clinicians as they use their judgement to work with patients.”

           CSRE sessions, which can take about a half hour, are designed to evaluate a veteran’s current risk factors and protective factors for suicide using a standardized checklist. Part of the appointment can be the development of a safety plan that maps out who the veteran can turn to when they feel suicidal, including the Veterans Crisis Line that can be reached by phone at 988, by text at 838255 and by online chat at https://www.veteranscrisisline.net/.

           Depending on the clinician’s judgment and the patient’s preferences, a CSRE can also lead to referrals to specific mental health care, the provision of free gun locks for any firearms the veteran possesses, and other steps. In some states, including Michigan, “red flag” laws allow clinicians, family members and law enforcement to seek a court order to remove firearms from the home of a person they believe to be a danger to themselves or others. The U-M Institute for Firearm Injury Prevention offers a free toolkit to help individuals understand this option called an Extreme Risk Protection Order.

           In addition to the factors that predicted suicide deaths by 30 or 365 days after a CSRE, Saulnier and colleagues also found some factors were actually linked to a protective effect, or reduced risk. More research on this is needed, he said – including research on those who completed CSREs and were considered very high risk for immediate or later suicide but did not die by suicide during the follow-up period.

           The team also found that some factors that have been seen in other research as protective against suicide risk were not associated with lower risk of suicide death, such as connection to others or a sense of hope. This may be due to the very high risk of suicide that veterans who receive CSREs already face.

           In an accompanying commentary, Rebecca Rossom, M.D., M.S. of the HealthPartners Institute wrote, “As the largest integrated health system in the US, true universal suicide risk screening followed by safety planning in the Veterans Health Administration could provide powerful evidence regarding the effectiveness of these approaches to suicide prevention. These findings are critical as the US continues to grapple with the public health epidemic of suicide.”

           The new study could help clinicians prioritize firearm-related steps for CSRE patients, as well as escalating patients with current suicide-related thoughts or plans to higher levels of care including inpatient psychiatric care if needed. Saulnier notes that predictive models for suicide have already become part of VA care management decisions, and that the new findings could help refine those models. He and colleagues are also planning to study what treatments veterans received after having a CSRE, and also non-fatal suicide attempts.

           To read the original article, find it with this reference:

Saulnier, K.G., Bagge, C.L., Ganoczy, D, et al. (2025). Suicide risk evaluations and suicide in the Veterans Health Administration. JAMA Network Open, 8(2): e2461559. doi:10.1001/jamanetworkopen.2024.61559