West, ru­ral ar­eas re­port high­est vet sui­cide rates

Arkansas Democrat-Gazette - - NATIONAL - HOPE YEN

WASH­ING­TON — Sui­cide among mil­i­tary veter­ans is es­pe­cially high in the west­ern U.S. and ru­ral ar­eas, ac­cord­ing to new gov­ern­ment data that show wide state-by-state dis­par­i­ties and sug­gest so­cial iso­la­tion, gun own­er­ship and ac­cess to health care may be fac­tors.

The fig­ures re­leased Fri­day are the first-ever De­part­ment of Veter­ans Af­fairs data on sui­cide by state.

It shows Mon­tana, Utah, Ne­vada and New Mex­ico had the high­est rates of vet­eran sui­cide as of 2014, the most cur­rent VA data avail­able.

Veter­ans in big chunks of those states must drive 70 miles or more to reach the near­est VA med­i­cal cen­ter.

The sui­cide rates in those four states stood at 60 per 100,000 in­di­vid­u­als or higher, far above the na­tional vet­eran sui­cide rate of 38.4.

The over­all rate in the West was 45.5.

All other re­gions of the coun­try had rates be­low the na­tional rate.

Other states with high vet­eran sui­cide rates, in­clud­ing West Vir­ginia, Ok­la­homa and Ken­tucky, had greater lev­els of pre­scrip­tion drug use, in­clud­ing opi­oids.

A VA study last year found that veter­ans who re­ceived the high­est doses of opi­oid painkillers were more than twice as likely to die by sui­cide com­pared with those re­ceiv­ing the low­est doses.

The lat­est VA data also reaf­firmed sharp de­mo­graphic dif­fer­ences: Women veter­ans are at much greater risk, with their sui­cide rate 2.5 times higher than for fe­male civil­ians.

Among men, the risk was 19 per­cent higher among veter­ans com­pared to civil­ians.

As a whole, older veter­ans make up most mil­i­tary sui­cides — roughly 65 per­cent were age 50 or older.

“This re­port is huge,” said Ra­jeev Ram­c­hand, an epi­demi­ol­o­gist who stud­ies sui­cide for the RAND Corp. He noted that the sui­cide rate is higher for veter­ans than non-veter­ans in ev­ery sin­gle state by at least 1.5 times, sug­gest­ing unique prob­lems faced by for­mer ser­vice mem­bers. “No state is im­mune.”

Ram­c­hand said it was hard to pin­point spe­cific causes be­hind vet­eran sui­cide but likely in­volved fac­tors more preva­lent in ru­ral ar­eas, such as so­cial iso­la­tion, lim­ited health care ac­cess, gun own­er­ship and opi­oid ad­dic­tion.

Na­tion­ally, 70 per­cent of the veter­ans who take their lives had not pre­vi­ously been con­nected to VA care.

“This re­quires closer in­ves­ti­ga­tion into why sui­cide rates by vet­eran sta­tus are higher, in­clud­ing the role that opi­ates play,” Ram­c­hand said.

The dataset of­fers more de­tailed break­downs on na­tional fig­ures re­leased last year, which found that 20 veter­ans a day com­mit­ted sui­cide.

The num­bers come from the largest study un­der­taken of veter­ans’ records by the VA, part of a gov­ern­ment ef­fort to un­cover fresh in­for­ma­tion about where to di­rect re­sources and iden­tify veter­ans most at-risk.

The de­part­ment has been ex­am­in­ing ways to boost sui­cide preven­tion ef­forts.

“Th­ese find­ings are deeply con­cern­ing, which is why I made sui­cide preven­tion my top clin­i­cal pri­or­ity,” said VA Sec­re­tary David Shulkin. “This is a na­tional pub­lic health is­sue.”

Shulkin, who has worked to pro­vide same-day men­tal health care at VA med­i­cal cen­ters, re­cently ex­panded emer­gency men­tal care to veter­ans with other than hon­or­able dis­charges.

The de­part­ment is also boost­ing its sui­cide hot­line and ex­pand­ing tele­health op­tions.

Ret. Army Sgt. Shawn Jones, ex­ec­u­tive di­rec­tor of Stop Sol­dier Sui­cide, said veter­ans sui­cide is an is­sue that needs greater aware­ness to pro­vide com­mu­nity sup­port for those in need.

Tran­si­tion­ing back to civil­ian life can be dif­fi­cult for ac­tive-duty mem­bers who may re­turn home with phys­i­cal and men­tal con­di­tions and feel un­able to open up to friends or fam­i­lies. As a re­sult, some veter­ans can feel over­whelmed by daily chal­lenges of find­ing a job, buy­ing a home and sup­port­ing a fam­ily.

“It can be tough be­cause the mil­i­tary is a close-knit com­mu­nity and you have that fa­mil­ial feel,” Jones said. “As you tran­si­tion out, you tend to lose that a lit­tle bit and feel like an is­land unto your­self.”

The at­ten­tion on vet­eran sui­cide comes at a time when the VA has re­ported a huge up­swing in veter­ans seek­ing med­i­cal care as they have re­turned from con­flicts in Afghanistan and Iraq.

Veter­ans’ groups say the lat­est data may raise ques­tions about the de­part­ment’s push to ex­pand pri­vate-sec­tor care.

“Veter­ans of­ten have more com­plex in­juries,” said Al­li­son Jaslow, ex­ec­u­tive di­rec­tor of Iraq and Afghanistan Veter­ans of Amer­ica, cit­ing lim­i­ta­tions if civil­ian doc­tors don’t un­der­stand the unique chal­lenges of the veter­ans’ pop­u­la­tion.

If doc­tors don’t ask the right ques­tions to a vet­eran com­plain­ing of back pain, for in­stance, they may pre­scribe opi­oids not re­al­iz­ing the vet­eran was also suf­fer­ing post-trau­matic stress dis­or­der PTSD or brain in­jury after be­ing blown up in a humvee, said Jaslow, a for­mer Army cap­tain.

Ex­pand­ing pri­vate-sec­tor care and stem­ming veter­ans’ sui­cide are pri­or­i­ties of Pres­i­dent Don­ald Trump. In a state­ment last week as part of Sui­cide Preven­tion Month, Trump said the U.S. “must do more” to help men­tally trou­bled veter­ans.

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