Research has shown that U.S. veterans are at high risk for suicidal thoughts and behaviors and death by suicide. In fact, prior to the pandemic in 2019, veterans accounted for 12 percent of all suicide deaths despite accounting for approximately 6 percent of the total population. A new study led by National Center for PTSD and Yale researchers analyzed data from a nationally representative sample of U.S. veterans to understand how the COVID-19 pandemic may have led to changes in suicidal thoughts and behaviors. The results were published online April 5 in JAMA Psychiatry. “Given elevated rates of suicide among veterans, there was concern that the COVID-19 pandemic might lead to an increase in suicidal thinking and behaviors,” said Ian Fischer, PhD, a clinical psychologist and postdoctoral fellow with the National Center for PTSD, and lead author of the study. “However, we actually saw a decrease in suicidal thoughts and behaviors.” The authors found that, at the population level, the prevalence of suicidal thinking decreased from 9.3 percent prior to the pandemic to 7.7 percent three years later. They also found that suicide planning and suicide attempts remained low throughout the pandemic and consistent with pre-pandemic levels. “Even though we know the pandemic generated considerable upheaval and uncertainty, it turns out it didn’t lead to increases in suicidal thoughts and behaviors in the veteran population,” Fischer said. However, the authors also found that a subset of veterans — approximately 5 percent — did develop suicidal thoughts or plans for the first time during the pandemic. In addition to tracking the prevalence of suicidal thoughts and behaviors, Fischer and colleagues identified factors that influenced whether veterans would contemplate or plan suicide for the first time during the pandemic. “We looked at several factors that might lead veterans to develop suicidal thoughts, plans, or attempts, including history of mental illness, loneliness, as well as social and financial stressors related to the pandemic,” said Robert Pietrzak, PhD, MPH, director of the Translational Psychiatric Epidemiology Laboratory of the National Center for PTSD, professor of psychiatry and public health at Yale School of Medicine and Public Health, and senior author of the study. Veterans with higher levels of purpose in life prior to the pandemic were less likely to think about suicide or make a plan to end their lives, the study showed. “Veterans with a stronger sense of purpose may have been better equipped to manage stress and seek out alternative goals when existing ones were disrupted,” Fischer said. Purpose in life refers to the extent to which individuals’ lives are directed and motivated by personally-valued goals and life aims. “It provides that sense of ‘why,’ which could help veterans to persevere in the face of uncertainty,” Fischer said. Conversely, veterans who had pre-existing concerns such as psychological distress and loneliness were more likely to develop suicidal thoughts during the pandemic. “Veterans with these risk factors may have been more sensitized to pandemic stressors and consequently developed suicidal thoughts or plans,” Pietrzak said. The findings, which provide further insight into factors that may lead veterans to contemplate suicide during times of stress and uncertainty, suggest that psychological treatments to promote purpose in life and social connectedness, as well as reduce psychological distress, may help reduce suicide risk in veterans. “I’m hopeful,” Fischer said. “These are things we can modify with treatment.” Other study authors include John Krystal, MD; Peter Na, MD, MPH; and Brandon Nichter, PhD, who are affiliated with Yale, National Center for PTSD, and VA Connecticut Healthcare System; and Sonya Norman, PhD, who is affiliated with the University of California San Diego School of Medicine and National Center for PTSD.