Suicide remains a major public health crisis in the United States, with national rates climbing more than 35% over the past two decades. Although veterans make up less than 7% of the U.S. adult population, they account for approximately 14% of suicide deaths, highlighting the urgent need to better understand the factors that contribute to elevated suicide risk in this population.
While suicide is shaped by a complex mix of biological, psychological, and social factors, less is known about how multiple adverse social conditions, when experienced together, may compound risk.
A new study led by researchers at the National Center for PTSD, VA Connecticut Healthcare System, and Yale School of Medicine provides one of the most comprehensive examinations to date of how cumulative social disadvantage is linked to suicide risk among U.S. military veterans. The findings were published Dec. 23 in JAMA Psychiatry.
“Many studies look at one social factor at a time—like poverty or weak social support,” says Peter Jongho Na, MD, MPH, staff psychiatrist at the VA Connecticut Healthcare System, assistant professor of psychiatry at Yale School of Medicine, and senior author of the study. “But in reality, hardships often cluster together. We wanted to understand how the accumulation of such hardships is linked to suicidal thoughts and behaviors in veterans.”
To address this question, the research team analyzed data from a nationally representative sample of more than 4,000 U.S. veterans. They examined 21 different social determinants of health—including financial strain, unemployment, limited access to health care, neighborhood disadvantage, and trauma exposure—and assessed whether veterans facing greater cumulative burden were more likely to report suicidal thoughts or behaviors.
The patterns were striking. Veterans in the top 5% of social disadvantage were more than 20 times more likely to report suicidal thoughts or behaviors than those experiencing the least hardship. The associations were even stronger among veterans with a history of mental health conditions.
“These findings show how profoundly social conditions can shape suicide risk,” says Robert H. Pietrzak, PhD, MPH, director of the Translational Psychiatric Epidemiology Laboratory at the National Center for PTSD, professor of psychiatry at Yale School of Medicine and of public health, and lead author of the study. “Education, income, neighborhood safety, and community support all matter. When several of these factors accumulate, the burden can become overwhelming.”
The study underscores the importance of identifying veterans who may be struggling with multiple forms of social disadvantage, not just those with traditional clinical risk factors. The authors note that strengthening programs that address housing stability, health care access, community belonging, and financial security may help protect veterans from reaching a point of crisis.
“This research highlights a simple but powerful message,” Pietrzak says. “Improving the social conditions in which people live, work, and age is not just good policy—it may save lives.”
The research team hopes these findings will inform future suicide-prevention efforts within the VA and broader health systems, underscoring the importance of comprehensive strategies that address not only mental health needs but also the social determinants that shape them.
Co-authors included Ian C. Fischer, PhD; Brandon Nichter, PhD; Irina Esterlis, PhD; John H. Krystal, MD; Christine Y. Moutier, MD; Maria A. Oquendo, MD, PhD; and Dilip V. Jeste, MD.