PTSD in Veterans: Risk Factors for Suicidal Thoughts

The good news? Treatment can help prevent it.

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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: