New data from the VA gives cause for hope among the veteran community, which has banded together in the battle against suicides. The VA’s 2021 National Veteran Suicide Prevention Annual Report examined data from 2019 compared to previous years, and found a decrease in the number of veteran suicides--and the lowest number of suicides since 2007. In revealing the news, the VA boasted the report is “the most comprehensive set of data about Veteran suicide mortality to date,” while cautioning that we still have much more work to do.
Despite the decrease in suicides among veterans, the veteran suicide rate stood nearly double that of the civilian population--at 31.6 deaths per 100,000 individuals compared to 16.8 among non-veterans. If the rates are adjusted for age- and sex-differences, the suicide rate in 2019 was 52.3% higher among veterans than among non-veterans. Total veteran suicides numbered 6,261, which amounts to 17 veterans dying of suicide per day.
While this number--in veterans' lives lost--is heartbreaking and staggering, there is reason for hope that suicide prevention efforts may be working, as there was a 7.2% decrease in suicides in 2019 compared to 2018 (with 399 fewer suicides). The reduction was greater among female veterans compared to males, with female numbers falling 12.8% and males by just 3.6%. This contrast makes evident that suicide prevention gains are not equal, though factors other than gender are highly influential.
It's worth recognizing that suicide rates fell among veterans who had recently sought VA care (a 2.4% decrease in the adjusted rate), while rates climbed among veterans who had not (a 2.5% increase). Along the same lines, in examining suicide rates among those diagnosed with depression who had sought VA care, rates fell from 72.9 per 100,000 in 2005, to 66.4 in 2018. Among those with anxiety who sought VA care, numbers from the same years showed a decrease from 83.1 to 67 per 100,000.
The news that there is a reduction in suicides among those who sought VA care must be welcome among VA providers, after a study was released last year calling into question the efficacy of the VA's first-line treatments. In particular, researchers questioned the effectiveness of both cognitive processing therapy (CPT) and prolonged exposure (PE), and whether or not clinicians had accurately understood and conceptualized the problems veterans face, and how to treat them.
Dr. Maria Steenkamp, the lead author of that study wrote, “Overall, these new findings suggest that first-line psychotherapies do not effectively treat military-related PTSD in large proportions of patients and do not outperform non-trauma-focused interventions.” In fact, the study found that these therapies only seem to be a clinical success for about 1/3rd of veterans--meaning they’re not very impactful for about 2/3rds--while other evidence seems to indicate that other interventions, including mindfulness, tend to yield comparable results.
The abstract of Steenkamp’s team’s study includes a statement that should not be overlooked, reading, “These findings have led to questions about the extent to which these therapies should be prioritized and how military-related PTSD is best conceptualized, namely as a disorder that can be reliably managed by brief (approximately 12 session) monotherapies or as a highly complex and multiform condition requiring more individualized and comprehensive intervention.”
Psychoanalytic psychotherapists tend to conceptualize post traumatic stress disorder symptoms as arising from two psychological defenses which begin to engage when they shouldn't. Those defenses are hyperarousal (which aims to detect and respond to threats) and dissociation (which numbs us from the potential or real physical or emotional pain of a traumatic experience). These defenses give rise to significant psychological, emotional, and physical discomfort, which is what leads into the pattern of avoidance symptoms that are so typical of a person who suffers from post traumatic stress.
Obviously, these are not the only problems veterans face--though they remain the focus of the first line treatments. Outbursts of anger, irritability, relationship difficulties, moral injury, aggressive tendencies, negative self-talk, self-shaming responses to emotional expression, and a lack of emotional flexibility may have a connection to post traumatic stress, but none of these experiences originate from the two defenses listed above--and therefore they cannot be treated effectively with therapies which aim to restore the healthy functioning of the above mentioned defenses. And, importantly, these problems can be just as destructive and potentially lead one to a degree of suffering that ultimately leads to suicide.
Experts both inside and outside the VA, to include Dr. Jonathan Shay and Dr. Edward Tick, have written about how veterans tend to get stuck in “combat mode” or who become psychologically entrenched in a warrior-centric way of being that keeps them from living the rest of their lives in a way that would lead to contentment or joy. This is not because of PTSD, and therefore such problems cannot be treated with the same therapies. Just as a person has to be initiated into warriorhood, one has to be initiated out of it if they are to transition without unreasonable hardship.
Non-profit therapeutic programs, such as The Battle Within’s Revenant Journey program, have been designed to address those problems which tend to be left out of the traditional therapies the VA employs. This program’s aim is to boost veterans’ emotional regulation capacity, making symptoms easier to manage, while at the same time helping veterans’ psyches to adapt from functioning for war and military service, to adapt for functioning in civilian and family life. It simultaneously helps set the stage for effective psychotherapy of almost any variety, by helping establish psychological factors, such as emotional flexibility and openness, which are critical for any therapy to work. As a combat veteran/psychotherapist who serves as the Clinical Manager of this program, I know there are dozens of our 700+ alumni body who might have been part of the suicide statistics in this report if our program did not exist. Importantly, our organization is just one of dozens of similarly impactful programs--usually led by veterans--who are putting a dent in the veteran suicide rate. The VA report doesn't, and can't, account for all the factors that might influence a decline in suicides among veterans--but it's safe to say that the veteran community as a whole is pulling a lot of the weight.
As we consider the VA’s recent report, it’s important to realize there’s still a lot that we--and the VA--can do better. While the numbers are down, it is a painful and terrible reality that 6,261 veterans died in 2019--and there’s no telling what the numbers in 2020 or 2021 will look like, given all that we’ve endured in recently. This issue must remain a top priority for the VA, and for the veteran and military community as a whole--so be sure to check on your buddies, and make sure you lean into the supports this community has developed to care for one another.
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