Since 2001, more than 6,000 U.S. veterans have died by suicide annually. In 2022, 6,407 veterans died by suicide - a rate of 34.7 per 100,000 veterans, which has been consistently higher than nonveteran rates. This is why we were very interested in this recent study by RAND on existing and prospective programs to prevent veteran suicide. RAND has consistently produced very good research when it comes to veterans' issues.

The authors identified 307 suicide prevention programs, 156 of which were currently operating and 226 that were proposed to expand existing services or initiate new programs, and created something they call the "RAND Suicide Prevention Activity Matrix" to evaluate them. Among the 226 proposed programs, the most common types are multifunctional digital health platforms (mobile health applications), suicide risk assessment tools, and real-time monitoring.

Ok, so what works, and what doesn't? According to the study, community-based suicide prevention initiatives show clear benefits, particularly when implemented through programs like the Garrett Lee Smith Memorial Act. Suicide risk screening and assessment tools are effective at identifying at-risk individuals, though they are better at current identification than predicting future risk. For psychological treatments, collaborative safety planning, cognitive behavioral therapy (CBT), and dialectical behavioral therapy (DBT) demonstrate small but positive effects in reducing suicidal thoughts and behaviors, including among veterans. Crisis services, particularly the Veterans Crisis Line, prove valuable, with most users reporting that these services helped prevent them from harming themselves. For veterans with mental health conditions, certain medications like clozapine and lithium effectively reduce suicidal thoughts and behaviors.

Several approaches show limited evidence but remain promising for future development. Real-time monitoring using digital technologies shows modest ability to detect suicide risk in real-time, though linkage to actual prevention outcomes hasn't been established. Stellate ganglion block demonstrates potential in reducing PTSD symptoms, while Caring Letters and postcards show mixed but interesting results for post-discharge support. Economic interventions have shown surprising effectiveness, with minimum wage increases associated with 1.9-4.6% reductions in suicide rates.

Many interventions currently lack sufficient evidence. Despite their popularity, expressive arts therapies, animal-assisted programs, and physical recreation when used alone haven't demonstrated clear suicide prevention benefits, though they may improve related mental health outcomes. Gaming interventions, passive entertainment, and religious/spiritual programming all require more rigorous research to determine their specific impact on suicide prevention among veterans.

The report strongly recommends prioritizing the implementation of evidence-based prevention activities, including community-based initiatives, suicide risk screening and assessment, noncrisis psychological treatments, crisis services, and pharmacotherapy for individuals with mental health conditions.

The report also has recommendations dealing with specific issues. For example, communities should conduct comprehensive needs assessments to identify gaps in suicide prevention activities, as different veteran subpopulations face unique challenges. Veterans in areas with high gun ownership may need different firearm safety approaches than those in metropolitan areas. Veterans with "other than honorable" discharges require strategies to overcome their ineligibility for VA benefits. Low-income veterans and recently transitioning service members each need tailored economic and transition support, while veterans who experienced military sexual trauma require both prevention of future incidents and targeted mental health care.

The report recommends applying different thresholds of evidence when considering various suicide prevention activities. While prioritizing evidence-based approaches remains crucial, organizations should remain open to novel programs with less robust evidence, particularly for veterans with severe suicidality who may have exhausted traditional treatments. This balanced approach should carefully weigh potential risks against rewards, reserving experimental treatments for appropriate cases while maintaining rigorous safety standards.

All in all, an important resource on an important issue.

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SEE ALSO: The Political Consequences of Medicaid Cuts

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