Veterans' Voices: A Qualitative Study on Veteran Theories of Suicide

Background and Purpose

Veterans struggling with community reintegration after military life face significant challenges including job insecurity, relationship difficulties, anxiety, social isolation, depression, and suicide.  Although mental health researchers have long studied suicide, little is known about how veterans explain the phenomenon of suicide.  This paper addresses the gap in published perspectives on suicide by including the voices and lived experiences of veterans themselves.

Methods

A phenomenological qualitative design was used to examine the lived experience of veterans, with a special focus on personal narrative theories of suicide.  In-depth, semi-structured interviews were conducted with 155 Veterans.  The sample is predominantly male (78%), mixed in ethnicity (72% White; 17% African American; 6% Latinx; 1% Native American).  All branches of the military and eras of service were represented, with 59% having seen combat, and a mean 9.47 years of military tenure.  Verbatim transcripts were coded and analyzed using template analysis and Atlas TI software in partnership with Veteran research consultants.

Results

Data analysis yielded 110 individual codes, categorized and organized into themes.  Many participants described attempting suicide, losing friends to suicide, and seriously contemplating suicide.  A central theme, grounded in military culture and training, was the perception of suicide as a legitimate (and for some honorable) solution to complex personal struggles.  Several factors contributed to this belief, with participants describing feeling hopeless and misunderstood by civilians.  Participants discussed the importance of military concepts such as honor, duty, and the alleviation of burden to others as related to the decision to take one’s life.  Veterans also described the loss of mission and purpose, which can lead to alienation and social isolation, another identified key risk factor. 

Participants further theorized suicide as related to traumatic exposure, moral injury, and unmet mental health needs (particularly post-traumatic stress and depression).  Most described help-seeking stigma, attributed to military ideals of stoicism, pride and need to mask vulnerability.  Veterans also discussed engagement in extreme high-risk activities that mirror the adrenalin rush of combat.  This phenomenon is associated with increased risk of mortality and may mask a desire for suicide.  Many also discussed access to firearms as an additional risk factor.  Finally, veterans identified protective factors including family and community support, meaningful work, mission and purpose, and veteran peer relationships. 

Conclusion

Findings suggest social workers need training in military culture to better understand and assess for unique suicide risk factors and behaviors.  Veteran perspectives and theories of suicide need consideration in policy-making, program design and intervention delivery.  Social workers intervening with veterans should emphasize prosocial activity, finding meaning/purpose, and strengthening peer relationships.  Through including veterans as a source of expertise and wisdom in policy and program implementation, social workers across multiple settings can help improve understanding of the veteran suicide phenomenon and work toward its reduction.