How to gauge the true extent of suicide by former service members? Two reports illustrate the challenge

The most recently released data from the U.S. Department of Veteran’s Affairs says the fewest veterans since 2006 died by suicide in 2020, according to the 2022 National Veteran Suicide Prevention Annual Report released on Sept. 19.

The data also showed that 2020 was the second year in a row the number of veterans who died by suicide decreased. In 2019, veteran suicides dropped by 307 while in 2020, the veterans who took their own lives decreased by 343 — which was the largest rate and amount drop since 2001, according to the report. In 2020, 6,146 veterans died by suicide, an average of nearly 17 for each day of the year.

“There is nothing more important to VA than preventing veteran suicide — it’s our top clinical priority,” said Denis McDonough, VA secretary in a September news release.

In Virginia, 181 veterans died by suicide in 2020 with four of five using firearms, according to the VA.

“Our methodology for creating this report is well-established and consistent, based on verified data from the [Centers for Disease Control and Prevention] and [the U.S. Department of Defense], and meets the quality and standards of a peer-review reviewed publication,” VA staff said in emailed comments. “In the interest of full transparency, we release yearly reports detailing how we come to the conclusions in the Annual Suicide Prevention Report.”

The VA’s data does have limitations, according to Daniel Gade, the commissioner of the Virginia Department of Veterans Services, Iraq combat veteranand two-time Purple Heart recipient.

One issue is the delay, which causes two complications — a failure show the full impact of COVID and loneliness on veterans mental health that continued into 2021 and the simple fact that issues on the ground can change quickly for veterans and a delay of two years to get the data back could miss more contemporary challenges faced by former military members, according to Gade.

Another issue is potential ambiguity in a cause of death, he said.

“There’s problems with identifying veteran deaths at all and then you add onto that veterans suicide deaths are often easy to mistake for other kinds of death,” Gade said.

Examples include if a veteran overdoses on opioids, whether it was on purpose or not, and if a veteran was driving at a high speed alone at night and dies in a wreck — the question of if they purposefully crashed, according to Gade.

Then he heard of a September report released by Georgia-based veteran’s group America’s Warrior Partnership that uses a different methodology. Their report, based on data from only eight states, but not Virginia, found the rate of veteran suicide would be nearly 2.5 times higher than the VA data if extrapolated nationally.

“What I think we’ve seen with America’s Warrior Partnership is they’ve taken an innovative approach to breakdown the data and find the magnitude of the problem” of veteran suicide, Gade said.

Though the AWP study finds a higher rate of suicide, it is not an attack on the VA and the AWP study has it’s own limitations as well, according to Cheree Tham, principle investigator for the study and a co-founder of AWP.

The group was first formed by Tham and Jim Lorraine in 2011 to try and find best practices in certain local communities that reduced veteran suicide that could match with similar communities. Two years later, they received funding to take the research national in 2013, according to Tham.

However, finding the data to solidify what approaches were working proved difficult, Tham said.

The process to find the data then turned into the study that found the higher rate of suicide among veterans than VA research, she said.

One thing they noticed was how doctors’ “sensitivity” to grieving families of a deceased veteran could impact record keeping, according to Tham.

“If they could err on the suicide of documenting it as an accident, under the definition of self-injuring mortality, and not as suicide, then they tended to do that for various reasons,” Tham said.

That meant only looking at death certificates that were classified as suicide would leave out potential suicides classified as accidents, she said.

Additionally, the AWP study used a much more broad definition of veteran than the VA, according to Tham.

“Our data that we’re taking is inclusive of those that don’t meet the legal definition of veterans,” Tham said. “That’s a lot of your National Guard, that’s a lot of your reservists.”

In its study, the VA defined veterans as people “who had been activated for federal military service and were not currently serving at the time of death.”

Though the AWP used a broader definition to count veterans than the VA, the data was only limited to what they were able to obtain from eight states, Tham said. That’s because those eight states provided the names and Social Security numbers of deceased veterans for AWP to get needed information about service history from the DoD, while there were privacy laws or other barriers to getting the information for deceased veterans in the other 42 states, according to Tham.

The states included in the AWP study were Alabama, Florida, Maine, Massachusetts, Michigan, Minnesota, Montana, and Oregon and the veterans in those states account for fewer than one in five of the veterans across the country, Tham said.

This also means that the figures and rates AWP came to during the study cannot simply be expanded out nationally and be completely representative of the situation across the country, according to Tham.

Using the data AWP collected, they found that roughly 24 former service members died by suicide, determined by a coroner or medical examiner, compared to an average of 17.7 veteran suicides a day, according to the VA. About five out of six of those deaths are self-injury moralities that were previously listed as accidents and undetermined with over four out five caused by overdoses, according to AWP.

“When I saw this report come out, my initial reaction was to reach out to Jim [Lorraine]and ask how can we help and how can Virginia be one of these states in this study?” Gade said.

Tham said other states have also reached out since the publication of the report in September and they are coordinating to try and figure out the next move.

There are resources for veterans in crisis. If you are a veteran in crisis, you can can call 988 and then press 1, text 838255, or start a confidential online chat with someone at the veteran crisis line at this link, according to the VA. Veterans in crisis can also go to any VA medical center regardless of discharge status of enrollment status with the VA, seek help at any emergency room or can call 911.

Ian Munro, ian.munro@virginiamedia.com