Running head: VETERANS SUICIDE 1
Veterans Suicide
and
Post-traumatic Stress Disorder (PTSD)
Stephen King
Liberty University
VETERANS SUICIDE 2
Abstract
As a Human service professional, you will be challenged. While not all veterans have Post-
traumatic Stress Disorder (PTSD). The fact is over 20 veterans a day choose to take their life.
Male veterans are 18 times more likely to kill themselves than civilian counterparts and female
veterans are 250 times more likely to commit suicide. Veterans assistance needs to act because
about 8 out of every 100 veteran has PTSD. The myth that a person with PTSD is going to
explode is well documented. Numerous things in a veteran’s life can be a cause for PTSD.
Upon returning from a war or service requiring one to do things out of the normal daily scope of
living, many veterans have found it hard return to the life they had before. PTSD is a mental
health problem that some people develop after experiencing or witnessing a life-threatening
event, like combat, a natural disaster, a car accident, or sexual assault. The direct correlation of
PTSD and suicide is ambiguous at best.
Keywords: post-traumatic stress disorder (PTSD), suicide
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Veterans Suicide
The suicide rate of veterans has increased it steadily increases every year. Suicide
prevention has become crucial to help with this growing epidemic. The numbers are not going
down. While in service an active duty military member will receive training to assist in this
epidemic semi-annually. In 2007, the Joshua Omvig Veterans Suicide Prevention Act, named
after a young veteran who commit suicide after returning home from Iraq. “This act required the
Secretary of Veterans Affairs to develop and implement a multi-faceted program to reduce the
incidence of suicide among veterans.” (Amato, Kayman, Lombardo & Goldstein, (2017).
Mandated training for all staff members who interacted with veterans along with a
prevention counselor at each facility. Unfortunately, this did not have the desired results and the
suicide rates of veterans actually went higher. In 2014, the VA reported that 20 veterans die each
day as a result of suicide (Kashiwa, Sweetman, & Helgeson (2017). In an effort to assist with the
growing amount of suicides the VA has a suicide hotline available every day and also offers its
services to family members and active duty personnel as well. Some risk factors for suicide
homelessness, substance abuse, mental health and lack of friends.
Resilience
In 2009, to help members of the military help them cope with negative consequences in
their life resilience became the theme. Specifically, in the United States Army an effort was
launched to help combat counterproductive thinking. This resilience program was taught first to
drill instructors to assist with new recruits. Eventually, this training was adopted by the
leadership of the Army and evolved to the Ready and Resilient campaign to assist all members
of the Army their family and veterans alike in dealing with the thoughts in a more effective way.
Based on positive psychology it was an effort to help soldiers cope with things more effectively.
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The training consisted of modules to assist all in their thoughts and how to process them
in a more effective way based on the Penn Resilience program by Dr. Karen Reivich of
University of Pennsylvania. This training was conducted in 10 days once the person had
completed the course, they were considered a Master Resilience Trainer. Utilizing this face to
face training the overall concept was to have the students learn these resilience skills and assist
them in their daily life.
This training was based on 6 core competencies: self-awareness, self-regulation,
optimism, mental agility, character strengths and connection. The approach was to have the
MRT use the training and personal stories to assist others with their negative situations and
provide them with the tools to overcome or look at it in a different way. The overall success of
this program relies heavily on the MRT. Resilience in the end is for all and helps the person
throughout their life.
Religion and Spirituality
In 2015, because the rise in suicides among veterans the Clay Hunt Suicide Prevention
for American Veterans Act was passed. However, it too was not successful. One reason was lack
of aftercare upon completion of training. The stigma of mental health treatment is hard to
surpass to this day for veterans. Another approach that is starting to gather weight is the bound
of religion and spirituality and how it can help with this growing issue. “Some empirical studies
have further suggested that certain religious and/or spiritual beliefs, practices, and/or affiliations
may be protective against suicide.” (Amato et al., 2017). Therefore, one could argue a loss of
faith could be a contributing factor. Having faith in a religion or being spiritual brings purpose
to a person’s life.
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“And we know that in all things God works for the good of those who love him, who
have been called according to his purpose.” Romans 8:28 (New International Version). With the
alarming rate of veteran suicides this approach of looking at the faith and spirituality of
individuals to help with their thoughts and emotions has shown to be promising. To actually be
able to definitely say that those who are religious and spiritual are less likely to commit suicide
would be farfetched.
If one’s emotions and reactions can be curbed by a presence of a higher being or faith,
then it would be a good start to assist in this growing dire situation. “Attention to patients’
religious and spiritual concerns may be critical to the prevention of veteran suicide. Faith, self-
respect, and other ideals are sorely tested by violence, suffering, and loss. Comfort that might
otherwise come from a sense of belonging can be elusive. Emotional issues like these are often
expressed in religious or spiritual terms.” (Amato et al. 2017).
Prevention
“Suicide in the U.S. military veteran population is an epidemic with a wide-ranging
impact on individuals, families, and society. Death by suicide is preventable.” (Kashiwa,
Sweetman, & Helgeson, 2017). Occupational Therapy is gaining appreciation in an effort to
assist with the veteran suicide rising numbers. The identification of veteran suicide prevention as
a priority by the VA has elevated this type of therapy.
Suicide prevention and the effort to lower has yielded positive results according to the US
Veterans Health Administration, but troubling trends remain (Kirsch, 2018). The fact is female
VHA veterans are more likely to commit suicide using poison or firearm. While male VHA
veterans are pronged to use a firearm as the common method to commit suicide (Kirsch, 2018).
There is an effort to control the means and reduce the opportunity. Prevention includes gun
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safety to assist all around the veteran in firearm awareness. Janet Kemp, the VA's National
Mental Health Director for Suicide Prevention, says: “While the overall rates of suicide among
VA patients has stayed steady over the past several years, there are indicators that VHA's
program for suicide prevention has led to positive outcomes.” (Kirsch, 2014). The first study of
those veteran’s who use VHA and those who do not was recently conducted and published on-
line (Hoffmire & Bossarte, 2015).
In this study on thing that stood out is that there is rising number of female veterans
committing suicide. “The observed percent increase in crude suicide rates from 2000 to 2010
was 25% among male veterans and 40% among female veterans. However, when considering
VHA utilization history, VHA-utilizing veterans were the only study group for which crude
suicide rates decreased (by 20%) over the study period.” (Hoffmire & Bossarte, 2015).
Post-Traumatic Stress Disorder (PTSD)
PTSD has been known by different names combat fatigue or shell shock to name a few.
“Suicides and officially recognized cases of post-traumatic stress disorder (PTSD) represent
tangible indicators of these invisible wounds of war” (Koven, 2017). Members of the military
have suffered from battle wounds since the beginning of time.
PTSD in itself is ambiguous in nature no one can say this directly causes PTSD it may be
an event or stress related. If you look at history one can find mentions of invisible wounds based
on combat. PTSD is one of the most common diagnosed disorder in the United States. The
origin of PTSD has been evolved from ancient texts. One myth is that only military veterans
who have experienced war are the only sufferers of PTSD. PTSD has been closely associated
with the rise of veteran suicide.
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Although, PTSD may be a contributing factor to the rise of suicide among veterans it is
not the only one. “Concern about the increasing suicide rates among military members and
veterans specifically has led to a proliferation of research on potential risk factors for death from
suicide with specific relevance to this population” (Gradus, 2018). People who choose to serve
their country do this on a volunteer basis for one reason or another to serve their country. There
have been numerous studies on PTSD and death by suicide.
However, the direct correlation of the two is still inconclusive. PTSD has no set way of
manifesting one may be depressed or angry and these emotions will cause the reaction. All
people have thoughts and they drive their emotions what they feel and do. So, we can see that to
quantifiably say PTSD and suicide are linked is unproven at best. One explanatory factor in the
PTSD-suicide linkage may be disruption to mood, including the experience of depressive
symptoms. (McKinney, Hirsch, & Britton, 2017). Also PTSD is not limited to only the military
community. The recent popularity of PTSD has been overwhelming.
Numerous things in a veteran’s life can be a cause for PTSD. Upon returning from a war
or service requiring one to do things out of the normal daily scope of living, many veterans have
found it hard return to the life they had before. PTSD is a mental health problem that some
people develop after experiencing or witnessing a life-threatening event, like combat, a natural
disaster, a car accident, or sexual assault.
Recent studies
In a recent study of 52 veterans volunteered to look at their spirituality using a scale to
assist in determining risk of suicide the data suggests that being diagnosed with PTSD can
threaten a veteran’s faith or spirituality (Raines, et al. 2017). The scale was used to assist in the
treatment for those suffering PTSD and looks further in to the individual’s beliefs. This study
VETERANS SUICIDE 8
not only looked at religious struggles of the veteran’s it also looked at their demographics,
alcohol use, depression history, drug use and their post-traumatic stress. A series of tests were
conducted resulting in the hypothesis of PTSD and faith or lack of could be a higher risk for
suicidal behavior (Raines, et al 2017).
Negative Emotions
These four negative emotions: anger, self-directed hostility, shame and guilt transition
into civilian life could lead to a veteran taking their life. (Rogers, Kelliher-Rabon, Hagan,
Hirsch, & Joiner, 2017). Anger as an emotion tied to suicide. This emotion in itself can cause
people to do things they would not usually do based on the severity of the emotion. Self-directed
hostility can be a coping mechanism for an underlying problem and that may lead to depression
or death. Shame and guilt these two emotions effect people in numerous ways.
Once a veteran is not in the service anymore the service being all they know it is hard to
not have counterproductive thoughts which could lead to guilt. These four emotions all
combined could be a factor in the rising number of veterans attempting suicide. A veteran is
more likely to experience life events that are also negative in nature thus compounding this with
thoughts can be overwhelming. “Although PTSD, depression, and anger have been examined as
independent predictors of suicide risk, a comprehensive model including all of these factors has
yet to be examined.” (McKinney, et al., 2017). Emotions and PTSD are both not able to be
defined as each person has different thoughts, what they feel. Emotions, what they do.
Transitioning out
Retirement, chapter and or separation these things are known as transition in one form or
another. Transition is scary and can be a negative in itself. We are all creatures of habit and
develop routines and once this is disrupted it is hard to get an edge. Once a person finishes their
VETERANS SUICIDE 9
time in service there needs to be more emphasis on mental health and assistance in combating
negative emotions to help the transitioning individual in their next adventure. Understanding a
more holistic way of dealing with PTSD and the thoughts and emotions surrounding an
individual may be a way to assist in the rising rate of suicides.
Meditation therapy is another avenue of approach that is yielding results. PTSD is an
epidemic and needs to be brought to the forefront and treated more effectively in the veteran
community. A concentrated effort to help those who suffer from PTSD needs to be implemented
from when someone is diagnosed whether in the service or not.
Human service professionals
Human service professionals could be key in this effort. Human service professionals
must have an array of characteristics these strengths could be paramount in tackling this issue. A
Human Service Professional needs an open mind and listen to other people’s perspectives. “Stop
judging by mere appearances, but instead judge correctly.” John 7:24, (New International
Version).
To able to accomplish this on must show empathy and by doing so being able to listen to
other people’s perspectives. Sometimes being able to listen to others can be the key to helping
others dealing with their problems. Compassion, towards your fellow man. Open mindedness
and the ability to listen to others without judgement. “Not looking to your own interests but each
of you to the interests of the others.” Philippians 2:4 (New International Version). Human
Service practitioners have been embedded with those who deploy to assist in time of crisis.
(Martin, 2018).
This practice dates back to at least World War I. “PTSD and the effects on the family are
very prevalent mostly in statistics the significant martial difficulties and homelessness.” “50%
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who those who suffer PTSD end in divorce (Kashiwa, et al., 2017). “Many veterans who are
devoid of visible disabilities have acquired invisible scars that negatively affect them throughout
their lifetimes. Both visible and invisible scars have severe repercussions for families, friends,
communities and the collective society.” (Koven, 2018). PTSD and the underlying affects can
be the tip of the iceberg. Most who suffer from PTSD are a have undying scars that they are
unable to cope with. The human service profession would be a great place for the VA to start and
assist in the growing PTSD community.
Stigma
As mentioned above the stigma of mental health is hard for some veterans to overcome.
When someone seeks help it is admitting a weakness. Someone who has relied on their personal
strengths to overcome negativity for them to admit a weakness is sometimes one of the hardest
things for them to do. The stigma of being mentally unfit or not functioning at full capacity is
instilled in military member from the beginning. Before it came to the forefront in the Military
mental health was a contributing factor to promotion. At one time seeking help was frowned
upon and it could affect your career.
Now that prevention and education are needed to assist people who struggle with PTSD.
When someone chooses to serve their country, they should be assisted in transition into society
more effectively then currently accomplished. Think about a veteran who served the bulk of his
life in the service now add a combat tour and different aspects of the daily military life. Though
not all who serve suffer PTSD with this growing number of cases it is crucial to plan for success.
The effort is not meeting expectations there needs to be more emphasis put on transition and
those who suffer PTSD.
VETERANS SUICIDE 11
We put such a worth on one serving it would be nice if the effort was put forth as they
start their new life without the service. The combination of negative emotions from PTSD and
the reactions that follow can be catastrophic to an individual and lead to negative impact in their
lives. Understanding that PTSD is treatable and can be treated will help those who suffer.
Unfortunately, PTSD is not going away it is now part of the daily vocabulary of a member of the
service and civilian counterparts.
Homelessness
At an alarming rate veteran are becoming homeless. The fact is homelessness and suicide
share so same similarities. In a recent study it found that a veteran with a history of
homelessness is five times more likely to attempt suicide (Tsai, Huang, & Pietrzak, 2018).
Given this information should the VA concentrate on suicide prevention and homelessness in the
same effort?
“Veterans kill themselves at twice the rate of their civilian counterparts.” (Tsai et al.,
2018). This needs to be addressed this is not acceptable. Programs or training is not enough we
are losing to many people. More effort is needed to help fix this growing problem once someone
has served it is necessary to assist them in anyway. We assist other countries with their problems
more than we concentrate on the home front. The VA is now shifting its focus from ending
veteran homelessness to preventing veteran suicides. (Tsai et al., 2018). The focus needs to be
a veteran as a whole not just a specific issue. Understanding, a veteran and their story will be
crucial to assisting them with their underlying problems.
Veterans Affairs Accountability
In a recent article of the Military times it was found that only 1 percent of the
allotted budget for preventing suicide was actually used. Meaning that of the $6.2 million set
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aside for suicide prevention media outreach in fiscal year 2018, only $57,000 was actually used.
Shane, Leo III, (December 18, 2018) VA left millions for suicide prevention unspent, The
Military Times retrieved https://www.militarytimes.com/
This is unacceptable the money is set aside to assist in veterans suicide prevention yet do
to lack of whatever it has not been used. “Unfortunately, VA has failed to do that, despite
claiming the elimination of veteran suicide as its highest clinical priority.” Rep. Tim Walz, D-
Minn. ranking member of the House Veterans’ Affairs Committee Shane, Leo III, (December 18,
2018) VA left millions for suicide prevention unspent, The Military Times retrieved
https://www.militarytimes.com/
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