How Does Discharge Status Affect Military Veterans' Mental and Physical Health and Suicide Risk?

Background: Considerable resources have been devoted to investigating and preventing suicide among military veterans, but rates remain high. In addition, most veteran suicide research has been conducted with veterans who are eligible for and seek services at the Veterans’ Health Administration (VHA). Little is known regarding suicide risk for veterans who do not seek VHA services. Even less is known about over 125,000 veterans who received non-honorable military discharges since 2001 even though these underserved veterans face substantial barriers to medical and mental health services and are likely to be at higher risk for negative mental and behavioral health outcomes including suicide.

Methods: We employed a purposive sampling strategy which included partnering with local institutions of higher learning and veterans’ service agencies to recruit 722 veterans living the in the San Francisco Bay Area. The sample comprised honorably discharged veterans (n=508) and non-honorably discharged veterans (n=214). We used t­-tests of independent samples to compare mean scores for these groups on constructs with known links to suicidality in veterans, including PTSD, depression, alcohol use, somatic symptoms, and physical functioning and disability. In addition, we employed a series of linear regression models to test relationships between predictors, discharge status, and suicide risk.

Results: Non-honorably discharged veterans demonstrated significantly higher mean scores than honorably discharged veterans on all suicide risk indicators. In the regression models, only somatic symptoms (β=.20, p­<.001) were significantly associated with suicide risk once discharge status was included (β=.33, p­<.001). In the final model, we detected a significant interaction effect for discharge status on the relationship between somatic symptoms and suicide F(3, 416), p<.001. The final model accounted for 31% of the variance in suicide risk.

Conclusions: To our knowledge, this is the first study to investigate differences in known suicide risk factors in honorably and non-honorably discharged military veterans. Study findings suggest that non-honorably discharged veterans, who face more barriers to mental and physical health care, endorse higher rates of mental and physical health problems as well as elevated risk for suicide compared to honorably discharged veterans. The magnitude of relationship between somatic symptoms and suicide risk was substantially greater in non-honorably than honorably discharged veterans, which suggests that somatic symptoms may warrant special clinical attention in this population. Additional research is required to improve understanding of the mental and behavioral health risks faced by this population.