Elizabeth M Haney, M.D.;
Maya Elin O'Neil, Ph.D., M.S.
Co-Investigators and Research Associates:
Susan Carson, M.P.H.;
Allison Low, B.A.;
Kimberly Peterson, M.S.;
Lauren M Denneson, Ph.D.;
Chandra Oleksiewicz, M.D.;
Devan Kansagara, M.D., M.C.R.
Evidence-based Synthesis Program (ESP) Center
Portland VA Medical Center
Portland, OR; Department of Veterans Affairs; March 2012
Suicide is a major public health concern in the United States (US), claiming over 36,000 lives
each year and nearly 100 lives each day, and suicide among military and Veteran populations is
of particular concern. Veterans returning from the Iraq and Afghanistan conflicts, referred to as
Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans, may be particularly
at risk, although the limited available data has shown mixed results. Several aspects of military
experience may increase the risk of suicide, including mental health and substance abuse.
Many risk factors specific to the OEF/OIF population have yet to be thoroughly evaluated and
incorporated into clinical management.
Ideally, suicide risk assessment tools need to account for the relationship among different risk
factors and identify risk factors or combinations of risk factors that are particularly associated
with suicidal self-directed violence. To be practically useful, such tools will be brief enough to be
conducted in a primary care setting and will identify a threshold beyond which preventive action
should be taken. Risk assessment tools should be able to discriminate those at high-and low-risk
for suicidal self-directed violence. Likewise, studies of emerging risk factors need to evaluate the
contribution of a new potential predictor of suicide and self-directed violence in the context of
known risk factors in order to weigh the contribution of the new risk factor against those that are
The objective of this report is to review recent evidence about risk factors and risk assessment
tools within Veteran and military populations to provide evidence for clinical practice guideline
development specific to these populations.