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Publication Briefs

Suicides Among Post-9/11 Veterans Surged from 2006-2020, Exacerbated by TBI

In 2020, the suicide rate among Veterans was 32 per 100,000 – a rate 57% greater than that of non-Veterans – and suicide was the second leading cause of death for Veterans under age 45. Veterans who served after September 11, 2001 (9/11) also have higher suicide rates than the U.S. population, with rates exacerbated by traumatic brain injuries (TBI). Between 2000 and 2020, more than 460,000 servicemembers were diagnosed with TBI. This study examined trends in suicide rates from 2006–2020 for Veterans with and without TBI compared to the U.S. adult population. The study cohort consisted of 2,516,189 Veterans who served on active duty after 9/11, were age 18 or older, and received at least three years of care in the Military Health System. Veterans who received VA care were required to have received at least two years of care. Researchers reviewed data from the National Death Index and the CDC, with demographic variables including age, biological sex, and race/ethnicity, in addition to deployment and TBI exposure.


  • In a large cohort of Veterans serving after 9/11, suicide rates increased more than 10-fold from 2006–2020, a significantly greater rate of change than in the U.S. adult population. Veterans with TBI had suicide rates 56% higher than Veterans without TBI and three times higher than the U.S. adult population.
  • From 2006–2020, suicide rates increased by 15% per year for Veterans with TBI, 14% per year for Veterans without TBI, and 1% per year for the U.S. adult population.
  • Suicide rates increased above 2006 levels beginning in 2008 through 2020 for Veterans and increased above 2006 levels beginning in 2012 through 2020 for the U.S. adult population.
  • From 2019–2020, suicide rates per 100,000 person-years increased from 80 to 91 for Veterans with TBI and from 50 to 57 for Veterans without TBI, but did not change among U.S. adults, remaining at 19 during both years.


  • Potential explanations for increases in suicide include increased risk of mental health diagnoses, substance abuse, and gun violence.


  • Limitations included potential misclassification of causes of death, underreporting of TBI exposure, exclusion of Veterans not seeking care in the Military Health System or VA, and residual confounding due to differences between Veterans and the U.S. adult population.

HSR&D partly funded this study. Dr. Pugh is a Research Career Scientist with HSR&D’s Informatics, Decision-Enhancement and Analytic Sciences Center in Salt Lake City, UT.

Howard JT, Stewart IJ, Amuan M, Janak J, Howard K, Pugh MJ. Research Letter: Trends in Suicide Rates Among Post-9/11 U.S. Military Veterans With and Without Traumatic Brain Injury from 2006–2020. JAMA Neurology. August 28, 2023;online ahead of print.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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