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The Suicidal Female Veteran
STUDENT
School of Behavioral Sciences, Liberty University
CCOU304: Christian Counseling for Women (D01)
Dr. Kristin Kellen
August 4, 2023
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Introduction
When God first created man and woman, they lived in harmony with their Creator and
the world around them. However, this peace did not last forever, and in Genesis 3, Adam and Eve
committed the original sin. Since sin entered the world, mankind has been living in sin’s shadow,
fighting demons of all sorts. Living under the curse of sin and fighting Satan’s influence every
day can be a heavy burden to carry, and, unfortunately, the burden becomes too heavy for them
to carry. Exhausted and with feelings of hopelessness and helplessness, and not knowing who to
ask for help, some decide to give up the fight and turn to suicide.
For the purposes of this essay, it is critical to provide operational definitions for different
terms related to suicide. First, suicide is defined as “taking one’s own life” (Kellen, 2022, p.
133). Suicidal ideations are the thoughts, ideas, or wishes surrounding suicide. And a suicide
attempt simply means that a person has made an attempt, whether or not the attempt was
successful (Kellen, 2022, p. 133).
In 2021, 12.3 million adults had serious suicidal ideations; 1.7 million adults attempted
suicide, and 48,183 people completed suicide (CDC.gov: Facts About Suicide, 2023). That
means that approximately 1 of God’s people, created in His image, dies by suicide every 11
minutes (CDC.gov: Facts About Suicide, 2023). Suicide is a scary topic, one that is often
considered taboo. However, it is a subject that must be addressed and examined further because
is the tenth leading cause of death in the United States as of 2020 (Kellen, 2022, p. 133).
Female Veteran Suicide
One special population that garners much attention when it comes to the topic of suicide
is United States veterans. They are our nation’s heroes, working around the clock to protect their
fellow Americans, often under tremendous levels of stress and danger. These heroes include
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women, which is the fastest-growing demographic in the veteran population, accounting for
about 9% of all veterans, a number that is expected to reach more than 15% by 2035 (Women
veterans report, 2017). And worrying trends among the female (or woman) veteran population
that warrant further examination and discussion, especially for those who wish to counsel
women.
Unfortunately, the topics of mental health and suicide remains incredibly stigmatized
despite the Department of Defense (DOD) and the Department of Veterans Affairs (VA) having
their respective suicide prevention initiatives. While the suicide rate among veterans has declined
since 2018, the average number of daily veteran suicides has increased overall from 6,001 in
2001 to 6,146 suicide deaths annually as of 2020; a net total of 145 more veteran lives lost every
year (2022 National Veteran Suicide Prevention Annual Report).
Statistics
Department of Veterans Affairs (VA) 2022 National Veteran Suicide Prevention Annual
Report discusses the most recent suicide trends in the veteran community. Current statistics
suggest that, on average, 16.8 veterans died by suicide per day in the year 2020, making the
suicide rate 57.3% higher than their non-veteran counterparts (2022 National Veteran Suicide
Prevention Annual Report). Further, among veterans ages 18 to 44 years, suicide is the second
leading cause of death, compared to being the tenth leading cause among the total U.S.
population (2022 National Veteran Suicide Prevention Annual Report).
While male veterans are more likely to die from suicide, female veterans are more than
twice as likely to die by suicide than civilian women. Moreover, between the years 2005 and
2017, the suicide rate among veteran women increased 60% (Denneson et al., 2020, p. 1). It is
still the second leading cause of death for female veterans 18 to 34 years old and the third
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leading cause of death for those between 35 and 44 years old (2022 National Veteran Suicide
Prevention Annual Report).
One reason for the difference in the rate of suicides between veteran and non-veteran
women is likely that veteran women are 15% more likely to use firearms in their suicide attempts
than non-veteran women (48.2% versus 33.3%). The second most used method for female
veterans is poisoning, including overdose in almost 27% of suicide attempts (2022 National
Veteran Suicide Prevention Annual Report).
Possible Reasons for Suicide Attempts
What They Have in Common
Counselors need to be aware that suicide is complex and there is never one single cause
of suicidal ideations. (Houston, 2017, p. 64). There are several reasons a woman may consider
committing suicide and many of them are non-discriminatory. In a study published by Denneson
et al., researchers interviewed a sample of 50 veterans about the circumstances surrounding their
suicide attempts (2020, p. 3). Women reported feelings of worthlessness, shame, and emptiness
stemming from feelings of powerlessness and poor interpersonal relationships and a subpar
support system. When they would ask for help, these veteran women were met with rejection.
Additionally, many women indicated that they were victims of sexual abuse and trauma (pp. 4-
5). Moreover, women may consider suicide out of bitterness and contempt toward another person
for having hurt them; their wish is to “hurt them back” (Kellen, 2022, p. 135). Again, none of
these reasons are unique to veterans or non-veterans.
Unique Considerations
Veteran women and non-veteran women are more alike than they are different. Female
veterans are still humans, image-bearers of their Creator with their own unique roles and
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functions. Yet there are several factors unique to veteran women that must be accounted for in
the counseling process in order to better understand their symptoms and assist in treatment
planning (Ross et al., 2015, p. 521).
Military culture is unique and complex; each branch has its own traditions, ways of
socializing, values, terminology and behavioral norms (Ross et al., 2015, p. 521). Not only do
veteran women carry the burdens associated with family, relationships, their role as women, and
as human beings living under the curse of sin, they bring additional stressors like recent
transitions from military to civilian life, chronic stress related to lengthy deployments, and the
horrors of combat (Houston, 2017, p. 173). Also, the female veteran may have been the victim of
military sexual trauma (MST), in which she was harassed or assaulted in the line of duty, which
research has linked to increased suicide risk (p. 176). Another concern for female veterans,
especially in the context of suicide, is that many do not enjoy the same amounts of camaraderie
and belongingness as their male counterparts, leaving them especially vulnerable to feelings of
loneliness and isolation (p. 175).
Finally, research suggests that men and women who join the military are more likely than
their civilian counterparts to have experienced difficult childhoods, including higher instances of
all types of abuse (Houston, 2017, p. 175). It is hypothesized that military-related stressors may
trigger or aggravate such wounds, leaving servicemembers and veterans more susceptible to
mental illness and suicidal ideations or behaviors (p. 175).
A Biblical Perspective of Suicide
Because humanity dwells in the shadow of sin, all are vulnerable to suicidal ideations and
Christians are no exception. There are conflicting perspectives on the topic of suicide within the
Christian community, so it is critical that counselors rely on scripture to guide them in counseling
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those at risk for suicide. While the Bible does not provide any prescriptive teachings on suicide,
there are several core beliefs in Christianity regarding why suicide is wrong.
Suicide is Sinful
God’s Commandments
The best place to begin is with the definition of what suicide is: it is self-murder (Potter,
2021, p. 3). Committing murder of any kind, whether it is homicidal or suicidal in nature, is a
violation of God’s sixth commandment, “you shall not murder,” given to Moses in the book of
Exodus (20:13, New International Version). Furthermore, sin is willful disobedience against
God; suicide is willful and therefore, a sin. Second, if God forbids taking the life of any image-
bearer, the sixth commandment extends to one’s own life (Potter, 2021, p. 2). In the same
passages regarding creation, it is made clear that God is the Ultimate Authority when it comes to
the creation of life and when life ends. If someone other than God ends a life, they are attempting
to impose their will on God, rather than submitting to his will (Potter, 2021, p. 2).
She is Precious
Another reason Christians believe that suicide is wrong is because our lives are not our
own; God owns our bodies, not us (Potter, 2021, p. 5). In 1 Corinthians 6:19-20, Paul says that
the human body is a temple of the Holy Spirit and was bought for the high price of Christ’s blood
on the cross. Therefore, we should honor God by caring for our bodies.
Moreover, one of the very first lessons Christians learn from the Bible is that God created
man and woman in his image, Imago Dei. And, when God saw all that he had made, it was very
good (Genesis 1:31, New International Version). Like every woman that came before her, the
counselee is just that, very good. She is beautiful, has a purpose and has potential, whether she
sees it or not (Kellen, 2022, p. 10). Therefore, to Christians, when someone harms their body in
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any way, especially through intentional death, they destroy a vessel of the Holy Spirit, something
that is precious to God, the Father (Potter, 2021, p. 6).
Suicide Hurts Everyone
Satan has multiple talents; they may be nefarious in nature, but the enemy is still good at
them. One thing Satan is good at is convincing us that lies are truth, even the lies we tell
ourselves in moments of weakness. In Genesis 3, Satan convinced Eve that God was fearful of
others being like him, which we know is a lie if God truly made humans in his image. In
convincing Eve of this lie, Satan sowed the seeds of doubt regarding God’s power and goodness;
Eve questioned her Father’s love for her. Because of original sin, those seeds of doubt remain.
One of the biggest lies a woman may tell herself is that she is a burden and others would
be better off if she died. First, research suggests that when someone commits suicide, they
drastically increase the risk of suicide among their friends and family who are grieving their loss
(Pitman et al., 2016, p. 8). Second, suicide hurts God; Jesus grieves for everyone in pain and is
also left to grieve the loss of another precious life. The pain a woman’s suicide would cause is
the antithesis of Jesus’ teaching that we are to love the Lord, heart, mind, and soul; and that we
are to love our neighbors as we love ourselves (Matthew 22:37-39, New International Version).
While suicide is a very serious sin, according to Counseling women: Biblical wisdom for
life’s battles, the wise counselor knows how to balance the sinfulness of suicide with the biblical
message of hope and God’s grace (Kellen, 2022, p. 137).
Counseling a Suicidal Veteran
Suicide is a heavy and intimidating topic, but counselors should not be afraid to ask
questions regarding suicidal ideations, intent, planning, or attempts. Sometimes counselees will
offer the information voluntarily and without prompting. Conversely, there are clients who may
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not offer such information for multiple reasons. For example, many veterans are accustomed to
the stigma in military culture surrounding mental illness and asking for help. Such situations
require the counselor to remain aware of any signs that it may be appropriate to screen for
suicidal ideations, such as in times of distress (Houston, 2017, p. 63). At the very least,
counselors should screen for and discuss suicide and suicidal risk during initial counseling
sessions and then more often, if needed (Kellen, 2022, p. 137).
Initial Steps
Risk Assessments
Not every suicide can be predicted or avoided. Nevertheless, suicide risk assessments are
the first step in ensuring client safety. During a risk assessment, the counselor gathers
information on the counselee’s personal history; for veterans, the counselor should ask questions
related to her military career. Any deployments, combat experience, and environmental stressors
may increase the likelihood of developing several mental health conditions; counselors should
also ask if the counselee has a history of mental illness because such conditions increase the risk
for suicide (Houston, 2017, pp. 35-56).
It is also crucial for the counselor to ask questions related to any past suicidal ideations,
self-harm behaviors, or suicide attempts. Research has found that 34% of people who entertain
suicidal ideations will develop a plan, 72% of whom will make an attempt (p. 63). Furthermore,
previous suicide attempts are typically the most reliable predictor of future attempts and
completed suicides; nearly one-quarter of those who previously attempted suicide will make a
subsequent attempt within 1 to 4 years and approximately 10% will eventually die by suicide
(Houston, 2017, pp. 63-64).
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Finally, risk assessments should also assess for protective factors, such as support
network, the health of their spiritual relationship with God, insight, and help-seeking behaviors.
For example, marital status, the presence of children, and cultural beliefs are all possible
protective factors that may help the counselee overcome suicidal ideations (p. 71).
Safety Planning
If the counselee indicates she is experiencing suicidal thoughts or intent, the counselee
and counselor should immediately complete a suicidal ideation action plan, sometimes also
called a safety plan (Kellen, 2022, p. 137). In this plan, or contract, the counselee should agree to
be open and honest and to notify their counselor should any relevant thoughts or events occur.
Also, the counselee should define the severity of an event or her thoughts; is she feeling
hopeless? Is she experiencing suicidal ideations without intent, or is she planning? Finally, in the
contract portion, the counselor should get the counselee to agree to speak up if she is ever feeling
unsafe.
Most importantly, the safety plan should clearly and simply outline prioritized coping
strategies for use in preventing or in the event of a suicidal crisis (U.S. Department of Veterans
Affairs, n.d.). The safety plan includes people and resources the veteran can contact should she
experience suicidal ideations or an acute suicidal situation (Kellen, 2022, p. 138). Included in the
list of contact information should be the phone number for the Department of Veterans Affairs
Veterans Crisis Line and the full-time suicide prevention coordinator at her local Veterans Affairs
Medical Clinic (Carroll, 2018).
Counseling Techniques
The Department of Veterans Affairs website cites several evidenced-based therapies that
they suggest their mental health professionals use in the process of suicide prevention. Three
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commonly used methods are acceptance and commitment therapy for depression (ACT-D),
cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT).
Acceptance and Commitment Therapy for Depression (ACT-D)
Acceptance and commitment therapy for depression (ACT-D) is a therapeutic approach
aimed at improving the lives of people, in this case veterans, who are experiencing depression.
Over the course of 12 to 16 psychotherapy sessions, ACT-D aims to reduce experiential
avoidance, which is any desire or action taken to eliminate painful or undesirable thoughts and
emotions (Walser et al., 2015, p. 26). Researchers theorize that, in instances of suicidal ideations
or suicide attempts, veterans view suicide as an effective method to avoiding problematic
emotional experiences (p. 26). Research suggests that veterans who completed the ACT-D
treatment protocol exhibited increased experiential acceptance and mindfulness, which resulted
in reductions in depression symptoms and an improvement in their quality of life (p. 26).
Cognitive Behavioral Therapy (CBT)
Another popular treatment used in suicide prevention is cognitive behavioral therapy
(CBT). Cognitive behavioral therapy focuses on the relationships between a person’s thoughts,
feelings, behaviors, and situations; CBT aims to assist veterans with changing undesired
behaviors through skill building and goal-setting (U.S. Department of Veterans Affairs, n.d.). A
2022 article by Vesco et al. examines three common CBT techniques that may be useful in
suicide prevention. First, the counselor and veteran work together to work on building hope and
examining reasons for living, typically through the completion of a “hope box,” which is a
container that contains items that remind the veteran of their reasons for living (Vesco et al.,
2022, p. 674). The second technique involves working with the counselee to build social skills,
forming a strong support network and strengthening existing positive relationships (p. 675). The
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third technique is lethal means counseling, which focuses on the importance of avoiding access
to lethal means such as firearms or pills (p. 676). Lastly, Vesco et al. cite research indicating that
using cognitive behavioral techniques is effective in reducing suicide attempt recurrence by 50%
to 60% (p. 672).
Dialectical Behavior Therapy (DBT)
Dialectical Behavior Therapy (DBT) is an evidence-based treatment often used at the
Veterans Affairs Medical Clinics with individuals who are at risk for suicide. DBT was originally
developed for use with individuals diagnosed with borderline personality disorder but has since
been adapted for use among other mental health patients, including veterans experiencing
suicidal thoughts, attempts, and self-harm behaviors (Bentley, 2021). DBT treatment protocol
includes several cognitive behavioral therapy techniques as well as teaching emotion regulation,
distress tolerance and interpersonal effectiveness skills (Bentley, 2021). To achieve these goals,
counselees learn mindfulness techniques, which allows counselees to observe and process their
current suicidal thoughts and any associated emotions, absent of the burden of guilt, shame and
judgment (Bentley, 2021).
Conclusion
On June 12, 1948, President Truman signed the Women’s Armed Services Integration Act
into law, which gave women the right to permanently serve in the United States armed forces.
Since then, millions of women have served their country honorably in various roles. However,
along with this honorable service comes a distinctive set of challenges each woman brings with
her into counseling. Not only is she struggling with the roles assigned to her by the Creator, but
she also carries the burdens inherent to military service, including various types of traumas,
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weakened interpersonal relationships and eventually the difficulties of transitioning to civilian
life.
While many female veterans share certain experiences, the wise counselor must
remember that each veteran is still a woman, an individual with unique needs and characteristics.
Further, counselors should also remember that any woman who is considering suicide is
suffering from a great deal of pain and one single stressor did not lead her to this particular
moment. The counselor must be compassionate and patient, walking along side the counselee
one day at a time while leading her back to her Heavenly Father who says, “come to me, all you
who are weary and burdened, and I will give you rest. Take my yoke upon you and learn from
me, for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is
easy and my burden is light” (Matthew 11:28-30, New International Version).
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References
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