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 Summary: The type of suicide prevention for military personnel and veterans that works best includes techniques to help current and former servicemembers to tolerate distress, regulate difficult emotions, and create a suicide crisis response plan.

Key Points:

  • Rates of suicide are higher among current military personnel and veterans than among non-military personnel and non-veteran adults in the U.S.
  • Suicide among military veterans increased between 2001 and 2021
  • Between 2021 and 2022, researchers recorded the first significant reduction in suicide among military personnel and veterans since 2001, with the exception of a small decrease between 2018 and 2020
  • Research shows some military personnel are at greater risk of suicide than others

New Study: Suicide Prevention Among High-Risk Military Personnel and Veterans

In response to data that shows and increase of 50 percent in suicide among military personnel and veterans – 20 percent higher than rates among civilian adults – a group of researchers designed a study called  “Brief Cognitive Behavioral Therapy for Suicidal Military Personnel and Veterans: The Military Suicide Prevention Intervention Research (MSPIRE) Randomized Clinical Trial” to answer this pressing question:

“Can brief cognitive behavioral therapy (BCBT) for suicide prevention reduce suicide attempts and suicidal ideation among high-risk suicidal US military personnel and veterans?”

The research team provides this context:

“Previous trials support the efficacy of brief cognitive behavioral therapy (BCBT) for reducing suicide attempts among military personnel compared with treatment as usual, and replication of these findings is needed.”

This is important research. People who join the armed services are willing to make significant sacrifices – up to and including risking their lives – to protect the safety and security of all U.S. citizens. As a society, we owe it to them to help them manage the mental health challenges that may occur as a direct result of their service, including disorder such as depression and post-traumatic stress disorder (PTSD) that significantly increase risk of suicide.

Here’s a sample of the data on suicide among military personnel and veterans, as compared to non-veterans:

  • 2022, unadjusted suicide rate for veterans: 34.7 per 100,000
    • Female veterans: 13.5 per 100,000
    • Male veterans: 37.3 per 100,000
  • 2022, unadjusted suicide rate for non-veterans: 17.1 per 100,000
    • Female non-veterans: 7.2 per 100,000
    • Male non-veterans: 28.7 per 100,000

That’s a significant change, and improvement, over the previous 20 years. For context – and to explain why researchers are actively analyzing this topic – let’s look at the trends in suicide among veterans and non-veterans over the 20-year period between 2002 and 2022.

Suicide Rates, Veteran and Non-Veteran: Dramatic Difference in Increase

Data from the U.S. Department of Veterans Affairs (VA) shows alarming trends highlighting the difference between military and civilian suicide rates over the past 20 years. These figures are publicly available in the following publications:

2024 National Veteran Suicide Prevention – ANNUAL REPORT – Part 1 of 2: In-Depth Reviews

2024 National Veteran Suicide Prevention – ANNUAL REPORT – Part 2 of 2: Report Findings

Here’s the data:

Suicide Among Veteran and Non-Veteran U.S, Adults, 2002-2022

  • 2002
    • Veteran: 16.9
    • Non-veteran: 15.0
  • 2004
    • Veteran: 18.0
    • Non-veteran: 14.7
  • 2006
    • Veteran: 18.0
    • Non-veteran: 14.6
  • 2008
    • Veteran: 21.1
    • Non-veteran: 15.1
  • 2010:
    • Veteran: 22.0
    • Non-veteran: 15.7
  • 2012
    • Veteran: 23.0
    • Non-veteran: 16.3
  • 2014
    • Veteran: 26.3
    • Non-veteran: 16.7
  • 2016
    • Veteran: 25.7
    • Non-veteran: 17.1
  • 2018:
    • Veteran: 27.7
    • Non-veteran: 17.9
  • 2020
    • Veteran: 27.1
    • Non-veteran: 16.6
  • 2021:
    • Veteran: 30.1
    • Non-veteran: 17.4
  • 2022:
    • Veteran: 28.1
    • Non-veteran: 17.8

Those figures, as we mention, are alarming. In 2021, for instance, rates of suicide among military personnel and veterans approached double the rates observed in the non-veteran population.

We’ll share another set of data from those reports: veterans at highest risk of suicide.

Veterans at Highest Risk: Top Five Groups

  1. Veterans with limited economic resources
  2. Those who receive VA care and report sexual trauma during service
  3. Veterans recently discharged from service
  4. Those who receive support in the community, but not from the VA
  5. Veterans who had an other than honorable (OTH) discharge

Those are the latest facts and figures on suicide fatalities among veterans, as compared to non-veterans, as well as the groups of veterans at highest risk of suicide.

Now let’s return to and review the study we introduce at the beginning of this article. We’ll learn whether brief cognitive behavioral therapy (BCBT) for suicide prevention for military personnel and veterans works best, compared to another well-established approach to suicide prevention for military personnel and veterans.

About the Study: Suicide Prevention That Works Best For Military Personnel and Veterans

The research team designed a study to compare two approaches to suicide prevention among military personnel and veterans, brief cognitive behavioral therapy (BCBT) and present-centered therapy (PCT). Researchers assigned participants from three outpatient clinics serving military personnel – all of whom reported either past-week or past-month suicidality – to receive treatment with BCBT or with PCT.

Before we examine the data, here are details on the two treatment approaches, starting with BCBT.

What is Brief Cognitive Behavioral Therapy (BCBT)?

BCBT is a 12-session psychotherapeutic method with the following characteristics:

  • Focuses on self-regulation skills to help people process difficult emotions and manage emotional distress
  • Includes strategies to process and reframe negative thoughts and beliefs that increase vulnerability to suicide
  • Begins with patient-centered suicide risk assessment
  • Assessment prioritizes collecting an accurate narrative account of recent suicidality
  • Provider and patient then collaborate to develop a treatment plan
  • Provider teaches patients effective crisis response plans and contingencies
  • Remaining BCBT sessions prioritize emotion regulation skills, including relaxation and mindfulness, in order to increase proficiency in skills that:
    • Reduce emotional reactivity
    • Promote behavioral inhibition
    • Enhance cognitive reappraisal skills
    • Counter maladaptive thoughts and beliefs that increase suicide risk
  • Final sessions focus on relapse prevention
  • Previous research showed BCBT led to significant decreases in:
    • Suicide attempts
    • Suicidal ideation

Now let’s look at PCT.

What is Present-centered therapy (PCT)?

PCT is a 12-session psychotherapeutic method with the following characteristics:

  • Education about symptoms of suicidality
  • Education about symptoms/factors that typically precede a suicide crisis
  • Helps patients understand their symptoms are a response to significant psychological, emotional, and life stressor
  • Providers offer emotional support
  • Providers offer input/analysis related to life problems
  • Patients receive guidance about how to handle significant distress
  • Patients receive guidance on increasing positive social and interpersonal experienes
  • Previous studies showed PCT helped patients with suicide-related diagnoses:
    • Reduced symptoms of post-traumatic stress disorder (PTSD)
    • Improved mood in patients with major depressive disorder (MDD)
    • Reduce instances of suicidal ideation

Both approaches can help prevent and reduce suicide in military personnel and veterans. However, both approaches included different components, which allowed researchers to contrast and compare two active approaches to suicide prevention. This is an essential step in research in suicide prevention for veterans, as previous research compared BCBT to treatment-as-usual (TAU), which lacks therapeutic components common to BCBT and PCT.

In other words, using PCT for comparison allowed researchers to determine, between the two approaches, which approach to suicide prevention for military personnel and veterans works best.

Let’s take a look at what they found.

Suicide Prevention for Military Personnel and Veterans: The Results

Among a sample set of 154 veterans with an average age of 33, participants reported a range of psychiatric and/or behavioral disorders, including:

  • Major depressive disorder (MDD)
  • Bipolar disorder
  • Panic disorder
  • Generalized anxiety disorder (GAD)
  • Attention-deficit hyperactivity disorder (ADHD)
  • Intermittent explosive disorder
  • Substance use disorder (SUD)

All were at high risk of suicidality, and all needed some sort of psychiatric support. Here are the results for the primary outcome measures of suicide attempts and time until suicide attempts, as well as the secondary outcome measure, intensity of suicidal ideation.

Brief Cognitive Behavioral Therapy (BCBT) Vs. Present-Centered Therapy (PCT) For Suicide Prevention

Suicide Attempts:

  • Suicide attempts, BCBT:
    • 6% (2 attempts)
  • Suicide attempts, PCT:
    • 9% (8 attempts)
  • Mean time until attempt, BCBT:
    • 756 days
  • Mean time until attempt, PCT:
    • 637 days

Suicidal Ideation Intensity:

  • Both groups showed significant reductions in intensity of suicidal ideation
  • Statistical analysis showed no difference in reduction in suicidal ideation between the BCBT and PCT groups

The research team theorized that differences between BCBT and PCT accounted for the increased positive effect of BCBT on primary and secondary outcome measures:

  • PCT focused on:
    • Monitoring daily stress
    • Active problem solving
  • BCBT focused on:
    • Emotion regulation
    • Cognitive reappraisal
    • Crisis response planning

Here’s how the research team describe their findings:

“This study found that BCBT is effective for preventing suicide attempts among high-risk military personnel and veterans. Taken together, these findings suggest these BCBT-specific procedures may uniquely account for the [superior] effect on reducing suicide attempts.”

We can use this information to help us support military personnel who are at high risk of suicide and report any type of suicidality: this data shows that BCBT – a modality with which we have extensive experience – can help reduce suicidality among military veterans. The data shows that, between BCBT and PCT, the intervention BCBT is the type of suicide prevention that works best.

That’s what we can do: offer the best possible support available to our military veterans. We’ll close this article with information from the VA report above about how the U.S. Department of Veterans Affairs plans to further reduce suicide among current and former U.S. military servicemembers.

What’s Happening Next? How to Prevent and Reduce Veteran Suicide

Here’s the long-range plan developed by the U.S. Department of Veterans Affairs, Office of Suicide Prevention (OSP): National Strategy for Preventing Veteran Suicide: 2018 – 2028.

7-Step National Plan to Reduce Suicide Among Military Personnel

  1. Secure Firearms
    • Enhance and expand efforts around safe firearm storage as a core component of suicide prevention, and offer free cable gun locks to veterans.
  1. Community Collaboration
    • Enhance and expand the development and maintenance of community programs focused on suicide prevention among veterans.
    • Use available resources to evaluate community suicide prevention programs for effectiveness at the local, state, and federal level.
  1. Improve Crisis Support and Intervention
    • Enhance and expand crisis support services for veterans.
    • Apply telehealth or other digital technologies to create new ways to communicate with and support veterans at risk of suicide.
  1. Custom/Individualized Prevention and Intervention Support
    • Enhance and expand programs that recognize the unique needs of veterans.
    • Offer improved support to underserved communities and ensure that “no veteran is left behind.”
  1. Expand Suicide Prevention to Include Non-Medical and Non-Psychiatric Areas of Support
    • Enhance and expand support for at risk veterans in the following areas:
      • Financial
      • Occupational
      • Legal
      • Social
  1. Provide a Full Continuum of Mental Health Access and Care
    • Enhance and expand mental health services for all veterans, across all stages of support
    • Communicate more readily and increase access to data and research for the entire military and veteran population
    • Create a more informed, engaged, and empowered military community, with respect to issues of mental health
  1. Integrate Suicide Reduction and Prevention Across Levels of Care
    • Include suicide prevention strategies in all medical milieu serving veterans
    • Ensure every veteran has access to every possible means of support

We think every component of this plan is crucial. We’re focused on offering the best possible suicide prevention support for military personnel and veterans. We’re one hundred percent behind the concept of No Veteran Left Behind.

Resources: Finding Support for Veterans With High Risk of Suicide

If you or someone you know is at risk of suicide, please get help immediately. Whenrisk is immediate, call 911 or go to the emergency room now: do not wait. If risk of harm is serious but not immediate, call or text the 988 Suicide & Crisis Lifeline at 988. The crisis line will connect you or the person in crisis to an appropriate level of support and care.

If you or someone you know is a veteran of the U.S. military, the 988 line has a dedicated support option available:

About Angus Whyte

Angus Whyte has an extensive background in neuroscience, behavioral health, adolescent development, and mindfulness, including lab work in behavioral neurobiology and a decade of writing articles on mental health and mental health treatment. In addition, Angus brings twenty years of experience as a yoga teacher and experiential educator to his work for Crownview. He’s an expert at synthesizing complex concepts into accessible content that helps patients, providers, and families understand the nuances of mental health treatment, with the ultimate goal of improving outcomes and quality of life for all stakeholders.