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Publication Briefs

Higher Risk of Suicidal Ideation among Veterans Seeking Mental Health Treatment from both VA and non-VA Facilities Compared to Veterans Seeking VA Treatment Only

Among current and former military personnel, research has focused mainly on suicide mortality, with relatively fewer studies about suicidal ideation and attempt – and fewer still examining the problem of suicidal risk among female Veterans. To answer the need for population-based epidemiologic data, VA researchers developed the Veterans Health Module (VHM) to be implemented within the Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS). This report presents data from the 2011-2012 VHM telephone survey, which was administered across 10 states (n=10,406 Veterans; 93% male). VHM survey items included lifetime diagnoses of mental illnesses, service in a combat zone, sources of mental healthcare, and past 12-month suicidal ideation and attempt. Stratifying by gender, investigators evaluated the association of different locations of mental health treatment (i.e., VA facility only, non-VA facility only, both VA and non-VA facilities) with suicidal ideation in the past 12 months. Investigators also conducted additional analyses using the subgroup of individuals who reported seeking mental health care (n=760).


  • After adjusting for sociodemographic and VHM variables, Veterans who sought mental health treatment from both VA and non-VA facilities had more than four-fold increased odds of suicidal ideation than Veterans who sought mental health treatment from VA facilities only.
  • Overall, 5% of the study cohort reported recent suicidal ideation, and 1% reported attempting suicide. There were no sex differences in prevalence of suicidal ideation or attempt.
  • Women were more likely than men to report a lifetime diagnosis of depression, anxiety, or PTSD (24% vs. 15% respectively). Men and women also differed significantly in where they received mental health treatment; e.g., while 3% of men reported receiving mental health treatment from a non-VA facility, 10% of women reported receiving mental health treatment from a non-VA facility.
  • Among men, unemployment was positively associated with suicidal ideation, while combat exposure was negatively associated with suicidal ideation. Among women, being separated, divorced, or widowed was positively associated with suicidal ideation.
  • In the overall sample, lifetime diagnosis of depression, anxiety, or PTSD was the strongest correlate of both suicidal ideation and attempt.


  • The VHM was not implemented by all U.S. states, which may limit generalizabilty.
  • The self-report nature of Veteran status may have contributed to misclassification bias by including persons who may not be Veterans as defined by official records of military service.
  • The study did not assess completed suicide and investigators were unable to accurately assess outcomes among Veterans exclusively seen in non-VA settings due to small sample sizes.

Dr. Blosnich is supported by an HSR&D Career Development Award (CDA 14-408) and is part of HSR&D's Center for Health Equity Research & Promotion (CHERP), Pittsburgh and Philadelphia, PA.

Blosnich J, Brenner L, and Bossarte R. Population Mental Health among U.S. Military Veterans: Results of the Veterans Health Module of the Behavioral Risk Factor Surveillance System, 2011-2012. Annals of Epidemiology. June 24, 2016;e-pub 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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