Suicides by veterans or members of the armed forces in recent years have resulted in public outcry and national legislation to prevent those who have served their country from taking their own lives.

However, much of the argument and outreach has rested on a thin and often contradictory base of evidence, according to a report from the Congressional Research Service.

"[T]here is not, at this time, a system of surveillance for suicide among veterans," said the report by Ramya Sundararaman, Sidath Viranga Panangala, and Sarah Lister, of the service's Domestic Social Policy Division." The true incidence of suicide among veterans is not known."

The Centers for Disease Control and Prevention (CDC) began the National Violent Death Reporting System (NVDRS) in 2003 to collect data on violent deaths from medical examiners, law-enforcement sources, and toxicology reports that go beyond information recorded on standard death certificates. The NVDRS permits recording whether a decedent has served in the U.S. armed forces, although that information is not always known to the person who fills out the death certificate. Furthermore, only 17 states participate in the NVDRS, limiting its generalizability.

In 2005, the NVDRS recorded 1,821 suicides among current or former members of the armed forces—although the system does not distinguish between the two. Almost all were male (97 percent), and 78 percent were 45 or older.

Other CDC databases, such as the National Death Index, can be compared with Veterans Administration (VA) patient records to try to identify suicides, but only one-third of U.S. veterans receive health care from the VA, limiting the usefulness of this approach.

A 2007 study by University of Michigan researchers that examined rates of suicide among veterans treated for depression between 1999 and 2004 found that 1,683 out of 807,694 veterans studied had killed themselves, a rate of 88.25 suicides per 100,000 person-years. That rate is higher than rates in the general population, but similar to rates among individuals with depression.

Comparing the suicide rates of veterans and the general population presents additional problems, said the report authors. "Such comparisons are often made, but they are not necessarily valid," they noted.

For one thing, suicide data about the general population include suicides by veterans. Few sources present suicide data among populations excluding veterans, and no one knows the extent to which the inclusion or exclusion of veterans alters the data for the general population.

Some veterans groups have also complained that suicides have gone unrecorded among recently discharged veterans of duty in Iraq or Afghanistan who have left the military health system and who have not signed up for care at the VA.

In addition, risky behavior by former troops, such as dangerous driving, drug use, or heavy drinking, may not be seen as linked to suicide and not recorded as such on death certificates. Both of these factors may skew the data about veterans' suicide.

Both the Department of Defense and Department of Veterans Affairs have taken steps to screen troops and veterans for suicide risk factors, according to the report. Military health policy calls for screening troops upon their return from assignment in Iraq, Afghanistan, or other active fronts and again six months later.

The VA has held suicide-awareness days, hired suicide-prevention coordinators for all its facilities, opened a 24-hour suicide-prevention hotline in cooperation with the Substance Abuse and Mental Health Services Administration, and launched two research centers that study suicide and its risk factors.

However, many of the goals set forth in the VA's Mental Health Strategic Plan in 2004 are still in the pilot phase or have been implemented only partially, said the authors.

Ultimately, they concluded, better research may be more useful than comparing veterans' suicide rates with those of the general population.

"What may be more meaningful, and more important to achieve, is the establishment of data systems that support a more robust and reliable understanding of suicide among veterans," the authors said. Such systems would include baseline data, risk and protective factors, and treatment outcomes, all of which would clarify the utility and timing of interventions.

"Suicide Prevention Among Veterans" is posted at<http://assets.opencrs.com/rpts/RL34471_20080505.pdf>.▪