Closing the Gap in Veteran Suicide Research

The U.S. military is celebrated for defending the interests and security of the nation, and yet research shows suicide rates are 52.3% higher among veterans than those who never served in the military.  

Duke University School of Medicine researchers are playing a part in reducing those numbers by creating effective and targeted veteran prevention suicide strategies. By combining state death records with military service data and incorporating insights from family, friends and colleagues, they hope to develop better tools and methods to prevent heartbreaking incidents that shatter lives and communities.  

Duke researchers have partnered with the America’s Warrior Partnership (AWP) on Operation Deep Dive, a study that may fill in the gaps in veteran suicide research.  

Candice Y. Johnson, PhD
Candice Y. Johnson, PhD

“There’s a pretty good amount of research showing that suicide rates are a lot higher among people who have served in the military, but there are gaps in our knowledge,” said Candice Y. Johnson, PhD, assistant professor in the Department of Family Medicine and Community Health

What’s known about veteran suicide trends is based on data from the U.S. Department of Veteran’s Affairs (VA), a good source of information about America’s veterans, she said, but it doesn’t capture those who are not affiliated with the VA once their service is over, or those who have been dishonorably discharged and ineligible for VA benefits.   

“Whether they’re involved in VA benefits or not, the military experience may impact the rest of their lives,” said Johnson, an expert in workplace health. “We are looking at all who served.”  

It’s a first-of-its-kind former service member suicide prevention study focusing on the role of community environments, such as housing and employment opportunities, and examining the impact of less-than-honorable discharges. 

The suicide prevention study began as a partnership between AWP and the University of Alabama, but going forward Duke will serve as the research lead.  

It’s a first-of-its-kind veteran suicide prevention study focusing on the role of community environments on former service members, such as housing and employment opportunities, and examining the impact of less-than-honorable discharges on former service member suicides.  

Additionally, Operation Deep Dive will expand its research to include self-harm and risky behavior such as overdose, accidental gunshot, and high-speed, single-driver accidents among former service members. 

Ashley Price, PhD
Ashley Price, PhD

“As AWP started to look a little more broadly at early mortality, they made a connection to those clinical researchers with the ability to touch on a diversity of illnesses and disease conditions,” said Ashley Price, PhD, senior research program lead in the Duke Department of Family Medicine and Community Health. “So, partnering with family medicine and community health made sense.” 

The first phase of the study led by Alabama revealed some patterns. It found that those who served in the military for fewer than three years had a greater risk of suicide, and that receiving a demotion during military service increased the odds of dying by suicide.  

Living with a partner decreased the odds of suicide by nearly 40%, according to the interim summary

The America’s Warrior Partnership has contracted with Duke for the second phase, to analyze state-provided death data from eight states and coordinate with the Department of Defense to confirm military affiliation and identify commonalities of the person, military service, and cause of death.  

As they study suicide prevention, Duke researchers will pay attention to several components of the military experience, such as number of service tours, how far away the service members were from family, and the length of their tours of duty.  

"We aim to identify some real clear predictors that inform community-based prevention for former service members at greatest risk,” said Price.  

Completing this picture of suicide risk will include working with the community to examine socio-cultural aspects of a person’s life before death.  

Laura Jane Fish, PhD
Laura Jane Fish, PhD

The AWP researchers will conduct a “verbal autopsy” of individuals suspected of dying by suicide by modifying a tool used by medical examiners called the Suicide Death Index. The index involves interviewing multiple people who knew the person to help determine what led to their death. Did the veteran see a losing battle with finding work? Maintaining relationships? Adjusting to civilian life? 

“The idea is to look at what factors in the last year of the person’s life that help predict what happened,” said Laura Jane Fish, PhD, assistant professor in family medicine and community health and a member of the Duke Cancer Institute who has studied quality of life among veterans.  

The multi-year project of data collection and analysis of interviews will be complicated and nuanced. But, the researchers said, it has the potential to save lives and honor those who served.  

As the previous researchers corroborated state death records with military service data from the Department of Defense, they found military service designations missing from some death certificates. 

“When we conduct analysis we will be able to flag that information and hope for the opportunity to give this back to states, so service members can have appropriate military burials,” Price explained. “That’s a tangible thing to deliver on to support families.”