Did the COVID Pandemic Worsen Suicidality in Veterans?

While suicidality among U.S. military veterans was of concern during the COVID-19 pandemic, rates of suicidal ideation were found to have decreased nationwide from November 2019 to December 2020, according to findings from a prospective population-based study.

Past-year suicidal ideation decreased from 10.6% before the pandemic to 7.8% during the pandemic, amidst ongoing disease outbreaks, reported Brandon Nichter, PhD, of the University of California San Diego, and colleagues.

“Despite grim forecasts about the COVID-19 pandemic creating a perfect storm for suicidal behavior, the prevalence of suicidality did not appear to increase at the population level,” the team wrote in JAMA Psychiatry.

Of the total sample, 82 veterans (2.6%) reported new-onset suicidal ideation over the study period. COVID-19 infection was found to be among the risk factors for developing suicidal ideation (OR 2.41, 95% CI 1.41-5.01).

Other risk factors included:

• Lack of a strong support network (OR 2.77, 95% CI 1.46-5.28)
• Previous history of suicide attempt (OR 6.31, 95% CI 2.71-14.67)
• Lifetime post-traumatic stress disorder and/or depression (OR 2.25, 95% CI 1.16-4.35)
• Past-year alcohol use disorder severity (OR 1.06, 95% CI 1.01-1.12)
• Worsening of social relationships during the pandemic (OR 1.47, 95% CI 1.16-1.88)

At the start of the pandemic, researchers suggested that U.S. military veterans may be at an elevated risk for suicidality, due to their already heightened risk of suicide and likelihood for chronic pain conditions compared with civilians.

For this study of 3,078 veterans ages 22 to 99 (mean age 63.2, 91.6% men), Nichter and team used data from the National Health and Resilience in Veterans Study, conducted from Nov. 18, 2019 to Dec. 19, 2020. Of the participants, 79.3% were non-Hispanic white, 10.3% were non-Hispanic Black, 6.0% were Hispanic, and 4.4% identified themselves in the “other” category, which included Asian, American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and multi-racial.

The researchers found that suicidal ideation decreased significantly for those ages 18 to 44, from 21.6% pre-pandemic to 15.4% peri-pandemic (P=0.002). This trend was also found among veterans ages 45 to 64 (15.7% to 10.3%, respectively, P<0.001).

In post-hoc analyses, veterans 18 to 64 years old reported a significantly greater increase in perceived social support over the study period compared with those 65 and older (Cohen d=0.22, P<0.001). This, the team wrote, fell in line with other longitudinal studies during the pandemic, “which indicated that age may be an important moderator.”

Nichter and team put forth several possible explanations for the overall decrease in suicidal ideation among veterans throughout the first leg of the continuing COVID crisis. First, based on emerging evidence, “older adults (e.g., veterans) may be more resilient to the deleterious mental health effects of the pandemic relative to younger populations, in part due to lower stress reactivity and better emotion regulation.”

They also suggested that military veterans “tend to have endured substantially more lifetime traumas and adversity relative to civilians, and therefore may be more accustomed to maneuvering through life’s challenges and weathering periods of prolonged stress.”

However, the likelihood that rates of suicidal behavior found among veterans were underestimated is a major limitation to the study, noted the researchers. The study also analyzed suicidal ideation using past-year ideation and suicide attempts, which impeded the researchers’ ability to establish whether ideation occurred before or after COVID-19 infection. Along with the issues of generalizability, due to its focus on a predominantly white male sample, it’s very probable that, as time goes on, more detailed reports of suicidal behavior in the veteran population will emerge, they added.

If you or someone you know is considering suicide, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).