A few months ago, I offered some thoughts on the Veterans Administration’s 2012 report on suicide rates among veterans. This month, the VA published an update of its analysis based on more recent data. News headlines have focused on what the press has characterized as a 44% increase among young veterans reported in the update. The headline is, at least in part, misleading.
The 44% figure is based on slide 7 in the 2014 report which tells us the following: of veterans enrolled in VA health system, the suicide rate among the 18 – 29 year old male population increased from a rate of 40.3 per hundred thousand in 2009 to a rate of 57.9 per hundred thousand in 2011. That is indeed an increase of 44% and a very troubling statistic. In fact, the entire range of 40 – 58 suicides per hundred thousand is troubling.
The headline, however, fails to capture the fact that the data only encompasses the population of veterans enrolled in the Veterans Health Administration (VHA) system. That’s significant. The VA’s 2012 report attempted to draw conclusions about all veterans by aggregating data from a wide variety of sources. The 2014 update focuses almost exclusively on VHA users.
Has the population of 18 – 29 year old VHA enrollees changed in the last three years? Have more veterans with suicide risk factors joined pool of VHA participants as Iraq and Afghanistan wound down and the VA increased its outreach to those who needed its services? Changes in the denominator matter as much as changes in the numerator.
Especially among the young, I don’t have much confidence that the VHA population mirrors the wider population of veterans. I have no direct experience of health care in the VHA, but as I near retirement I have become increasingly curious about it. Here is a link to the VHA’s 40 page booklet explaining health benefit eligibility based on time and place of service, service-related disabilities, certain military awards, income levels and eight different levels of priority. That’s not 40 pages of rules; it’s a 40 page advertising brochure that tries its best to explain a rather complex eligibility and co-payment system in plain English. If I were young, healthy, well-employed and without a service-related medical issue, I suspect I might look elsewhere for my health care.
The VA also notes that the overall suicide rate for non-veterans has also increased during this same period. The suicide rate for males in the general public increased by more than 27% in the first decade of the millennium, while the rate for females increased more than 31%. During the same period, the rate for male veterans enrolled in VA health care decreased by 16%, while females enrolled in VA health care saw the same rate of increase as females in the general population. Still, the comparisons aren’t pretty when you graph them. The veterans’ trend lines always hover well above the general public’s trend lines.
I imagine that the Veterans Administration was greatly dismayed by the way the press characterized its report. For the most part, it was trying to tell a good news story: that its care for veterans is improving and making a difference. The rate of suicide among VHA users with diagnosed mental health conditions or previous suicide attempts has dropped remarkably since 2001. That should mean that the VA’s behavioral health care has become more effective. Additionally, the overall rate of suicide among VHA users has gone down while the rate among veterans who have not enrolled for VHA services has gone up. That should mean that treatment actually helps those who are suffering, and that’s good news indeed.
If you are a veteran who’s suffering from depression, PTSD symptoms or contemplating suicide for any reason, please seek help from the Veterans Health Administration or other health care provider. There is hope. Choose life.