Strength in Connection: How Social Well-Being and Identity Shape Suicide Risk Among Veterans

Background/Purpose: Veteran suicide rates remain nearly twice as high as those of non-veteran adults in the United States, underscoring the urgent need to better understand both general and military-specific risk and protective factors.Guided by the Three-Step Theory (3ST) of suicide, an ideation to action framework, this study seeks to distinguish correlates of suicidal ideation from those of suicide attempts. It aims to extend current knowledge by exploring how individual characteristics, suicide risk factors, military identity, and social well-being are associated with distinct forms of suicidality.

Methods: This study used data from the Military Health and Well-Being Project (N = 1,483), collected by a nationally representative online survey of US veterans in 2020. The dependent variable categorized Suicidal Thoughts and Behaviors (STB) into three groups: no suicidal thoughts or behaviors (reference group), suicide ideation only, and suicide attempt. Predictors included suicide risk factors (e.g., loneliness, moral injury, substance use), military identity (e.g., idealism, professionalism, self-stigma), social well-being (social integration and contribution), and individual characteristics (age, gender, race and ethnicity). We used hierarchical multinomial logistic regression to examine how these factors were associated with the likelihood of suicidal ideation or suicide attempts, relative to no STB. The analysis was conducted using R Version 2024.09.1+394.

Results: In the sample, 5% reported a suicide attempt and 37% endorsed ideation only. Suicide risks were positively associated with substance use (Odds Ratio (OR) = 1.39, p < .001 for ideation; OR = 2.04, p < .001 for attempt) and loneliness (Ideation: OR = 1.14, p = .003; attempt: OR = 1.25, p = .015). Notably, STB was inversely associated with social integration (OR = 0.79, p < .001 for ideation; OR = 0.66, p < .001 for attempt) and social contribution (OR = 0.76, p = .027 for attempt). Additionally, gender minorities (female, transgender, and non-binary) were more likely than males to endorse suicidal ideation (OR = 1.61, p = .001) and suicide attempt (OR = 4.02, p < .001). A significant interaction effect was found between moral injury and self-stigma (OR = 0.99, p = .025 for ideation only compared to no STB), revealing that higher military self-stigma attenuated the association between moral injury and suicidal ideation.

Conclusions and Implications: This study contributes to the literature by: (1) differentiating correlates of ideation and attempt in a veteran sample using an ideation-to-action framework; (2) highlighting social connectedness as a key protective factor, particularly for veterans who likely have acquired capability for suicide; and (3) identifying a complex interaction between a key risk factor (moral injury) and military-based identity factor (military self-stigma) that challenges dominant narratives about stigma as solely a risk factor. The study highlights the importance of fostering community connection for transitioning service members—even before separation from service—through programs that support military-to-civilian adjustment. Notably, suicide prevention need not be limited to clinical interventions; engagement in community spaces such as sports teams, faith groups, or veteran service organizations (e.g., Kiwanis, Veterans of Foreign Wars, American Legion) may also offer powerful protective effects.