The good news? Treatment can help prevent it.
Suicidal thoughts may be common in veterans with PTSD, or post-traumatic stress disorder. Still, not all veterans have PTSD, and not all veterans with PTSD experience suicidal thoughts. So what are the risk factors for suicidal thoughts in veterans?
PTSD leads to negative thinking patterns in the brain. This can then progress to suicidal thoughts, according to Collin Reiff, MD, psychiatrist at NYU Langone Health.
“[PTSD] can increase feelings of shame [and] feelings of guilt,” says Dr. Reiff. “Then there's the whole part of feeling like, ‘What's the point of even continuing to live my life? This horrible thing has happened to me. I don't know how to make meaning of it.’”
In many cases, some veterans with PTSD have negative thoughts about themselves. This can lead them to thinking that they don’t deserve to get better or to have a good life. As a result, feelings of hopelessness are common and may lead to suicidal thoughts. Learn more about how military service may affect mental health here.
The Effects of Alcohol on Suicidal Thoughts
Veterans with PTSD who do not receive treatment are particularly at risk for suicidal thoughts. That's because they're more likely to turn to negative coping strategies. “They may try to self-medicate with substances such as alcohol. They may use stimulants, they may use cannabis,” says Dr. Reiff.
Substance use and misuse is very common among people with mental illnesses, including PTSD. While substance use may soothe PTSD symptoms temporarily, they may worsen problems in the long run. In fact, substance use may increase one’s risk of suicidal thoughts and suicide attempts.
“The danger … is that alcohol is a stimulant in low doses, and a depressant in high doses,” says Dr. Reiff. “That can disinhibit the individual and lead to impulsive activity.”
If someone is already having suicidal thoughts, and then they experience impulsivity from alcohol, they are more likely to have a suicide attempt. Statistically, suicide accounts for 20 percent of deaths related to alcohol, according to the U.S. Department of Health and Human Services.
Thoughts About Death
“Another thing to consider is that our veterans … may have at times accepted that there's a high probability that [they’re] going to die,” says Dr. Reiff. “In a certain regard, death may not be as foreign to them.”
Some veterans may come home with an intrusive thought that they weren’t “supposed” to survive their military service. According to U.S. army veteran Anthony Aiello, some of his suicidal thoughts stemmed from an idea that he was “meant to have died in the war.”
“That's something else that tons of veterans go through—this feeling that they shouldn't have survived the war [because] they just weren't meant to survive,” says Aiello.
The Communal Effect of Suicide
The prevalence of suicide within the veteran community can be devastating. “The veterans rely on each other. They went out to war together,” says Dr. Reiff. “It's important for them to have that subgroup of individuals and members who appreciate one another, who have a shared identity, so they enable each other to push forward and to make progress.”
It’s damaging on its own to lose one member of the group. They might be a friend or an important member of one’s support system. To make it worse, it may have a rippling effect on the community.
“It's devastating when one of the members of that subgroup is lost because it communicates to the other members within the subgroup that 'I wasn't able to overcome this burden, and you might not be able to overcome this,'” says Dr. Reiff. “It wears away at the community, this shared identity, and it's almost as if they're losing the war after the war.”
Get more information about suicide prevention here:
Collin Reiff, MD, is an addiction psychiatrist at NYU Langone Health and a clinical assistant professor at NYU Grossman School of Medicine.
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PTSD can lead to suicidal thoughts
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because it causes negative alterations in cognition.
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(somber piano music)
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It can increase feelings of shame,
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feelings of guilt, so there's that part of it.
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Then there's the whole part of
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what's the point of even continuing to live my life?
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This horrible thing has happened to me.
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I don't know how to make meaning of it.
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Oftentimes that happens to people who have
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I don't deserve to have a good life.
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I may never get better.
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And so what can happen is they can start to feel hopeless
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about their current situation and the future.
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An individual sufferer with the symptoms of PTSD,
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if they're not in treatment,
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they may try to self-medicate
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with substances such as alcohol.
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They may use stimulants, they may use cannabis.
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The danger of that, specifically with alcohol,
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is that alcohol is a stimulant in low doses
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and a depressant in high doses.
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That can disinhibit the individual
and lead to impulsive activity.
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Another thing to consider is that our veterans
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that have served may have already
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more or less dealt with the idea that I'm gonna die,
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and they may have at times accepted
there's a high probability
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that I'm gonna die in this situation,
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so in a certain regard,
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death may not be as foreign to them.
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I had this idea that I was
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meant to have died in the war.
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That's something else that tons of veterans go through.
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This feeling that they shouldn't have survived the war,
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not because their friends died,
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but they just weren't meant to survive.
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Not only that, it removes a veteran
from the community.
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And the veterans rely on each other.
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They went out to war together.
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Oftentimes civilians have a hard time relating
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or really understanding what our veterans do,
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and they do a lot,
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so it's important for them to have that subgroup
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of individuals and members
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who appreciate one another,
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who have a shared identity,
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so they enable each other
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to push forward and to make progress.
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It's devastating when one of the members
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of that subgroup is lost because it communicates
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to the other members within the subgroup
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that I wasn't able to overcome this burden,
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and you might not be able to overcome this.
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It wears away at the community,
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this shared identity,
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and it's almost as if they're losing the war after the war.
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- Does alcohol and other drug abuse increase the risk for suicide? Washington, DC: U.S. Department of Health and Human Services, 2008. (Accessed on August 27, 2020)
- Mental health: suicide prevention. Washington, DC: U.S. Department of Veterans Affairs. (Accessed on August 27, 2020)
- Post-traumatic stress disorder. Bethesda, MD: National Institute of Mental Health. (Accessed on August 27, 2020)