Suicide rates among veterans are higher than those of the general US population. Although veterans compose only 7.6% of the US population, nearly 14% of American adult suicides are among veterans. The rate of suicide is 1.5 times higher among all veterans and 2.1 times higher among female veterans compared with the general population. Only 47% of all veterans are enrolled in the US Department of Veterans Affairs (VA) Healthcare System, leaving a large number either not receiving health care or receiving it outside the VA. Recent legislation has improved access to care for veterans outside the VA, highlighting the need for a broad public health approach to address veteran suicide and the need for all health care institutions and clinicians to be familiar with the unique health concerns in this population. The purpose of this narrative review was to summarize the risk factors contributing to veteran suicide and to provide guidance on how to assess and mitigate these risks. Suicide is preventable through recognition of risk and prompt intervention. Health care providers both inside and outside the VA system are uniquely situated at the intersection of the many contributing factors to veteran suicide and should have a structured, proactive approach to address the problem.
Veterans of military service pose a special case both in their susceptibility to addiction and their risk for a co-occurring disorder, posttraumatic stress disorder. The elements of a military history are provided; this is not intuitive, and is salient both for determining entitlement status and to assess the cumulative injury. Numerous pain syndromes can occur as the result of both long-term wear and tear and abrupt injury, requiring consideration for disability compensation. PTSD and traumatic brain injury are more common here than perhaps among any other occupational group. Unique risks and concerns accompany the experience of warfare in different theaters; special sections are devoted to Iraq and Afghanistan; the first and second Gulf wars; and to Vietnam. Women constitute a newly enfranchised military group as subject to injury as their male cohorts. Several pain care innovations have been championed by the Veterans Administration, and these are described.
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