Rural Veterans’ Thoughts on High Suicide Rates in Their Communities—and on What to Do About It

Veterans’ Perspectives highlights research conducted by HSR and/or QUERI investigators, showcasing the importance of research for Veterans – and the importance of Veterans for research.

In the July - August 2025 Issue:

• Introduction: Veterans are twice as likely as non-Veterans to die by suicide, a contrast even more pronounced in rural settings—but until now, no structured attempt has been made to learn rural Veterans’ perspectives on reducing suicide in their communities.
• The Project: A team at VA’s Center to Improve Veteran Involvement in Care (CIVIC) at the VA Portland Health Care System designed a quality improvement project to provide empirical guidance for Veteran suicide prevention approaches in these communities.
• Results: Surveys of rural Veterans, followed by stakeholder group meetings, identified three priorities for further evaluation and improvement.
• Next Steps: Future research should explore the results of enhancing and expanding rural Veterans’ access to:
• socio-economic resources;
• person-centered healthcare; and
• a strong sense of community.

Introduction

The suicide rate among U.S. Veterans is twice that of non-Veterans, and Veterans are more likely than non-Veterans to live in rural communities that tend to have relatively fewer resources, opportunities, and connectivity. Veterans living in rural areas have a 20 to 22 percent higher suicide risk than urban Veterans, and rural U.S. counties with large numbers of Veteran residents are often “hotspots” of higher-than-expected suicide rates.

Given these circumstances, rural Veterans are a high-priority population for enhanced suicide prevention approaches. While previous research suggests that social and environmental factors play a larger role in suicide risk than individual psychiatric and demographic variables, the limited amount of research into these factors has yielded inconclusive results and insufficient guidance.

To help close this gap, and to generate recommendations for future research and programming in community-level Veteran suicide prevention, a team from VA’s Center to Improve Veteran Involvement in Care (CIVIC) at the Portland VA Health Care System devised a quality improvement project to identify priorities in these high-risk communities. The aim of this project was to provide empirical guidance for suicide prevention approaches focused on the needs of rural Veterans.

The Project

Design: To begin, the team identified rural Oregon counties with higher-than-expected Veteran suicide rates. Because one of the best sources of information about a community is the lived experience of its people, the investigators conducted qualitative interviews to develop a fuller understanding of these high-risk communities, and to identify issues of greatest importance to affected Veterans. The project is the first known effort to integrate the perspectives of Veterans in identifying priorities for rural community suicide prevention.

The Survey: The investigators recorded and transcribed qualitative interviews with 28 rural Veterans to understand their experiences and perspectives. Responses were analyzed for common and pertinent topics. These topics were grouped into organizing themes and, to confirm their relevance, discussed with a group of Veteran consultants outside Oregon.

Stakeholder Meetings: The team discussed interview findings with community stakeholders who lead or work in organizations that support rural Oregon Veterans, to learn their thoughts about which were most important—and about how they might be addressed. These findings were further refined in discussions with national VA leadership

Results

From this process, three main recommendations emerged for future research and discussion:

Increase capacity, accessibility, and awareness of socio-economic resources. Veterans described a lack of employment, housing, and mental health services in their communities:

“There’s nothing here.”

"We're just really a resource desert."

Many Veterans were unaware of available support networks or other resources. Some struggled to navigate complicated systems:

" …someone's usually… not walking around looking for bulletin boards to help them. Being approached by somebody doesn't always help, but that helps open them up, I think, to talk about what's really bothering them."

Stakeholders recommended building on existing community efforts, rather than creating new programs, with outreach that "meets Veterans at their doorstep."

Strengthen access to person-centered healthcare. Rural Veterans faced significant barriers to care, including long travel distances to VA facilities and insufficient local healthcare services. Many Veterans linked these challenges directly to suicide risk:

"…after you've tried for so long, you can't find or get help, you give up. Some of them just give up all the way. Why bother? I'm not going to get any help. The only help I can get is so far away, to hell with it. And that's why I think the suicides are so high."

Other Veterans cited frustration with frequent provider turnover that disrupted continuity of care and trusting relationships:

". . . every other month it felt like my doctor was changing. They're like, 'Oh, well your doctor moved away. You have a new doctor.' And then again, you just start talking to this new one and they move away. Nobody stays here."

Telehealth, one of VA’s most powerful tools for expanding the reach of healthcare, had mixed acceptance, with some Veterans finding it impersonal and difficult for building trust.

Build a stronger sense of community cohesion. Despite describing "tight knit" communities, many Veterans felt isolated and desired more opportunities for social connection, such as community events and gathering spaces:

"Just something where you could go and even just sit around and sit and be with other Veterans."

"When people feel connected, it reduces that suicidal ideation. And so getting people connected to one another and to different things that are happening in the community would be a priority."

Many participants noted that younger Veterans seemed less engaged with traditional Veteran organizations:

 "The [younger Veterans] that I know have children, kids or whatever. So they have their hands full. There's a guy on my street. I see him every now and then. We chat, and he's saying that he knows he has friends around town that are Veterans, but he just didn't have time to get with them. And so he was asking me about the AMVETS meeting. He wants to join, but he just doesn't have time."

"They're growing up in a time where things are so you don't know who your neighbor is.. . . you don't trust people."

Next Steps

The project revealed a target-rich environment for research and programming to improve Veteran-centered suicide prevention efforts in high-risk communities. The team mentions several possibilities, including:

• Evaluating strategies and methods for increasing Veteran awareness of, and access to, available resources, particularly outreach models that “meet Veterans at their doorstep” rather than expect them to seek help;

• Investigating alternative care models to retain providers in rural areas, extend healthcare access into rural communities, and adopt more patient-centered telehealth approaches that foster trust and support; and

• Studying the impacts of a sense of community on suicide rates while evaluating different community-building activities, particularly methods that build community trust and engage younger Veterans.

The project team cautions that none of these ideas is an endorsement or recommendation: “ . . . though we present some suggested approaches for Veteran suicide prevention within the identified priority areas, we did not test any specific approaches and therefore cannot provide recommendations for adoption or use. Additional work is needed to further evaluate such approaches.”

Lauren M. Denneson, PhD, is the Associate Director of the VA Portland Health Care System’s Center to Improve Veteran Involvement in Care (CIVIC) and professor in the department of psychiatry at Oregon Health and Science University. Dr. Denneson is a social psychologist studying suicide prevention, focusing on patient-centered and solution-focused approaches to care as well as community- and systems-level prevention.

Project Publication

Denneson LM, Kemp KL, and Tompkins KJ. Veteran Perspectives on Priority Areas for Rural Community-level Suicide Prevention. Journal of Rural Mental Health. March 2026; online ahead of print.

References

U.S. Department of Veterans Affairs Office of Mental Health and Suicide Prevention. 2024 National Veteran Suicide Prevention Annual Report, Part 2 of 2: Report Findings. MentalHealth.va.gov;7-8.

McCarthy JF, Blow FC, Ignacio, RV, et al. Suicide among patients in the Veterans Affairs health system: Rural-urban differences in rates, risks, and methods. American Journal of Public Health. March 2012;102(S1):S111-117.

Kreisel CJ, Wilson LK, Schneider AL, et al. Reducing rural veteran suicides: Navigating geospatial and community contexts for scaling up a national veterans affairs program. Suicide and Life Threatening Behavior. April 2021;51(2):344-351.

Denneson LM, Bollinger MJ, Meunier CC, et al. Veteran suicide and associated community characteristics in Oregon. Preventive Medicine. May 2023;170:107487.

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The views expressed in this publication are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.