Study: Vets show decrease in suicidal thoughts, behaviors during pandemic

By Susan Gonsalves
July 5th, 2023
Director, Translational Psychiatric Epidemiology Laboratory, Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for PTSD
Robert H. Pietrzak, Ph.D., MPH, clinical psychologist and director of the Translational Psychiatric Epidemiology Laboratory, U.S. Department of Veterans Affairs National Center for PTSD.

Subset group has these experiences for first time

Some evidence suggests the COVID-19 pandemic led to increases in loneliness, isolation, substance use, and financial insecurity, all issues that may increase suicide risk.

U.S. military veterans are particularly at risk of death by suicide. Prior to 2019, veterans accounted for 12 percent of all suicide deaths despite comprising about six percent of the total population.

“Research from our and other groups suggests that we should also make efforts to `build what’s strong’ and promote psychological strengths and social connections.” -- Ian Fischer, Ph.D., clinical psychologist, postdoctoral fellow, National Center for PTSD

With those factors in mind, researchers from the U.S. Department of Veterans Affairs National Center for PTSD and Mental Illness Research Education and Yale School of Medicine conducted a study using data from a national sample of more than 2,000 veterans (“National Health and Resilience in Veterans Study) to understand how the pandemic may have led to changes in suicidal thoughts and behaviors.

Those findings, published in “JAMA Psychiatry,” in April, demonstrated a decrease in suicidal thoughts and behaviors, going from 9.3 percent pre-pandemic to 6.8 percent at its height and then to 7.7 percent two years later.

“At each time point, we looked at a broad range of sociodemographic, military, health, and psychosocial factors that might lead veterans to develop suicidal thoughts, plans, or attempts,” explained senior author Robert H. Pietrzak, Ph.D., MPH, clinical psychologist and director of the translational psychiatric epidemiology laboratory at the Center.

These factors included history of mental illness, loneliness, as well as social and financial stressors related to the pandemic, added Pietrzak, also a Yale professor.

The study results showed suicide planning and attempts remaining low throughout COVID-19 and consistent with pre-pandemic levels. However, there was a subset of veterans, five percent, who had suicidal thoughts and plans for the first time during the pandemic.

Lead author Ian Fischer, Ph.D., is a clinical psychologist and postdoctoral fellow at the Mental Illness Research and Treatment Program, sponsored by the National Center for PTSD and Clinical Center at VA Connecticut Healthcare System.

Fischer said the results are consistent with a large body of research indicating that most people are resilient to stressful life events, even protracted ones like the pandemic.

But he emphasized it is critical to acknowledge the subset of the population that continuously needs treatment to help them adapt during times of stress and uncertainty.

Approximately 580,000 U.S. veterans or 3.8 percent of the sample contemplated suicide for the first time during COVID-19. About 180,000 or 1.2 percent of the veterans, for the first time, went so far as to create a plan to end their lives.

“Fortunately, the U.S. Department of Veterans Affairs (VA) offers a broad range of treatment options that can help veterans manage distress and suicide risk, as well as increase sources of resilience, such as purpose in life and social connection,” Fischer said.

He referred to several mobile self-help apps like PTSD Coach, Insomnia Coach, and Mindfulness Coach, and treatment companion apps such as CPT [cognitive processing therapy] Coach, PE [prolong exposure] Coach, and ACT [acceptance and commitment therapy] Coach that can be used in collaboration with mental health providers.

During the pandemic, the National Center for PTSD developed the COVID Coach, a self-help app providing information on how to stay safe and healthy during the pandemic. It includes tools for managing stress, improving social relationships, and identifying positive experiences that can improve mood.

Ian Fischer, Ph.D., is a clinical psychologist and postdoctoral fellow at the Mental Illness Research and Treatment Program, sponsored by the National Center for PTSD and Clinical Center at VA Connecticut Healthcare System.

Ian Fischer, Ph.D., is a clinical psychologist and postdoctoral fellow at the Mental Illness Research and Treatment Program, sponsored by the National Center for PTSD and Clinical Center at VA Connecticut Healthcare System.

“These apps are great resources, and ones that veterans who are used to being self-sufficient tend to like. I continue to recommend them to the veterans I treat as a way to supplement what we do in individual psychotherapy,” Fischer said.

Fischer noted that humans have a “fundamental need” to connect with others. “We also crave direction and the feeling that our lives matter—that what we are doing serves a purpose.”

He said mental health professionals are trained and tend to focus on trying to “fix what’s wrong in our patients…” Instead, Fischer said, “Research from our and other groups suggests that we should also make efforts to `build what’s strong’ and promote psychological strengths and social connections.”

He added, “In doing so, when unforeseen stressors arise, our patients will be better equipped to successfully navigate and overcome them.”

The researchers are currently using data from the original NHRVS to study the factors that increase and decrease the likelihood that veterans will develop suicidal thoughts and behaviors over a 10-year period.

Pietrzak said they are also seeing the same factors, such as purpose in life and social connectedness, predicting the thoughts and behaviors over a longer time period.

“This is encouraging because many of these factors are modifiable and could be targeted in prevention and treatment efforts,” Pietrzak said.

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