Suicide among veterans is a serious issue, and researchers are working to find better ways to prevent it. A recent study looked at veterans who received a suicide risk assessment through the Veterans Health Administration (VHA) and identified key warning signs that could help predict which veterans are most at risk.
These findings may help doctors and mental health professionals take better steps to prevent suicide among veterans.
What the Study Examined
The study focused on veterans who went through a suicide risk assessment called the Comprehensive Suicide Risk Evaluation (CSRE). This assessment has been in use across VA clinics for six years. The researchers specifically looked at veterans who received the assessment during its first year of nationwide use.
They analyzed how many of these veterans later died by suicide and what risk factors were most common among them. The study examined suicides that occurred within 30 days and within one year of the assessment.
Key Findings
Even after going through the CSRE process, some veterans remained at a high risk of suicide. The study found that those who had the following factors were the most likely to die by suicide:
- Current suicidal thoughts – Veterans who were actively thinking about suicide were at higher risk.
- A history of making suicide plans – If a veteran had previously made a specific plan to take their own life, their risk was greater.
- Access to firearms – Veterans who had guns at home were more likely to die by suicide.
- Previous stays in mental health hospitals – A history of inpatient mental health treatment was linked to a higher suicide risk.
The study found that out of 269,374 CSRE assessments completed for 153,736 veterans between November 2019 and December 2020, 791 veterans died by suicide afterward. Of these deaths:
- 144 suicides happened within the first 30 days after the assessment.
- The remaining suicides occurred within a year after the assessment.
Most of the veterans who died by suicide had been classified as high-risk by the CSRE, but some who were considered lower-risk also took their own lives. This shows that suicide prediction remains challenging, even with structured assessments.
What This Means for Suicide Prevention
The study, published in JAMA Network Open, was led by Dr. Kevin Saulnier, a psychologist at the VA Ann Arbor Healthcare System. He pointed out that predicting suicide has always been difficult, but these findings confirm that certain risk factors can help identify those who need urgent help.
Although the study did not look at what treatments veterans received after their assessments, the results could help doctors make better decisions when working with high-risk patients.
How the CSRE Assessment Works
A CSRE session usually takes about 30 minutes. It helps mental health professionals understand a veteran’s risk factors, such as past suicidal thoughts, mental health history, and access to weapons. The assessment also looks at protective factors—things that might help prevent suicide, like social support or a sense of purpose.
In some cases, the CSRE leads to a safety plan that includes:
- A list of people the veteran can reach out to for help.
- Crisis support resources, like the Veterans Crisis Line (which can be reached by calling 988, texting 838255, or using online chat).
- Steps to reduce suicide risk, such as free gun locks for veterans with firearms.
If a veteran is in immediate danger, the clinician might recommend inpatient psychiatric care or additional mental health support.
The Role of Firearm Safety
One major finding from the study is that firearm access plays a big role in suicide risk. Since veterans often have higher gun ownership rates than the general population, researchers suggest that firearm safety should be a bigger part of suicide prevention efforts.
Some states, including Michigan, have red flag laws that allow family members, doctors, or law enforcement to request a court order to temporarily remove firearms from a person at risk of harming themselves. The University of Michigan’s Institute for Firearm Injury Prevention provides a free guide on this option, known as an Extreme Risk Protection Order.
Next Steps for Research and Prevention
Dr. Saulnier and his team are planning more research to understand what happens to veterans after their CSRE assessments. They want to study what treatments veterans received and whether they had non-fatal suicide attemptsafter their assessments.
They also found that some factors normally linked to lower suicide risk—such as social connections or feelings of hope—did not make a difference for the veterans in the study. This could mean that veterans who receive CSREs are already at such high risk that these protective factors don’t have a strong impact.
Final Thoughts
This study highlights the importance of early intervention and continuous support for veterans at risk of suicide. It suggests that:
- Veterans with suicidal thoughts, past suicide plans, firearm access, or past hospital stays need extra attention and care.
- Firearm safety should be a bigger focus in suicide prevention efforts for veterans.
- More research is needed to understand what treatments work best after a CSRE assessment.
As the U.S. continues to face a suicide crisis, this research may help VA clinicians and mental health professionals provide better support for veterans. By identifying the highest-risk individuals and taking steps to protect them, more lives could be saved.
For veterans in crisis, help is available through the Veterans Crisis Line (988, text 838255, or online chat). If you or someone you know is struggling, don’t hesitate to reach out for support.
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The research findings can be found in JAMA Network Open.
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