The Statistics of Veteran Suicide: Is “22 a Day” the best way to look at the problem?

(U.S. Army photo illustration by Pfc. Paige Pendleton, 1st BCT, 1st Cav. Div. PAO, via http://www.army.mil)

Note: I want to credit Cassandra Bayer, Marta Galan, and Brett Webster. They were my amazing teammates for the capstone presentation in our Quantitative Methods class last fall. I came up with the topic of veteran suicides, and they did the real work of framing the topic in a statistical- and policy-oriented manner that I could never have done on my own. I mostly try to steer away from pilfering their excellent work here, but at least some of the ideas below are theirs.

This post was originally published here on January 11, 2016.

Twenty-two veterans commit suicide every day. This statistic is derived from a Veterans Affairs report published in 2012. It has been perpetuated by the news media, politicians, and social media, and it is the namesake and focus of numerous organizations. “22 a Day” has even spawned a handful of “awareness” fitness routines, including CrossFit WODs and yoga challenges.

Although she wasn’t the first journalist to challenge the efficacy and accuracy of the statistic, WaPo’s Michelle Ye He Lee fact-checked the figure early last year. Hers was followed by several similar articles, many of which drew the same conclusions I did upon first reading the 2012 VA report for context. Interestingly, the 2012 report is chock full of warnings and caveats about the incompleteness and potential problems with the figures it presents.

Here are my chief concerns with “22 a Day.”

“22 a Day” fails to accurately convey that the majority of veteran suicides are older veterans, and it does not include active duty service members.
It’s easy to assume that the 22 veterans committing suicide daily are younger veterans ailing from rotation after rotation to Iraq and Afghanistan. The fact is, the majority of those 22 are older veterans over 50 years of age.

Source: “Suicide Data Report, 2012,” Department of Veteran Affairs, Mental Health Services, Suicide Prevention Program

Of course that doesn’t diminish the urgency of the matter. What it does (or should do) is focus the issue’s lens and allow policymakers to develop appropriate responses with regard to funding and targeting.

Similarly, “22 a day” focuses exclusively on separated and retired service members. The Department of Defense tracks active duty and reserve component suicides as a wholly independent statistic that presents its own set of concerns.

“22 a Day” suffers from statistical flaws.
At the time of its publication, the 2012 report presented conclusions backed by only 21 states worth of data because they had “reached a point of statistical significance allowing for analysis of available data.” Statistically speaking, that would make sense, except that the report did not include data from several states with the nation’s largest concentration of veteran populations, including California and Texas, each of which counts over 1.5 million veterans in its population.

“Only 67% of female veterans were correctly identified.”

Further, there are issues with misidentification of veteran status associated with death certificate errors. The study relied on state-generated death certificates to identify the deceased as a veteran.

When a death certificate is generated, someone has to fill out a form. Generally speaking, veteran status is identified by someone checking the correct block on that form. Sometimes the block is mistakenly checked; sometimes the block mistakenly goes unchecked.

While the report’s authors deemed the margin of error for males acceptable, only 67% of deceased female veterans were correctly identified as such on their death certificate.

“22 a Day” fails to contextualize the issue.
Is the 22 a day rate for veteran suicide higher than the general population? This data was originally unavailable or inconclusive in 2012, but a study published in the Annals of Epidemiology in February 2015 concluded that veterans of the Iraq and Afghanistan wars “had 41% to 61% higher risk of suicide relative to the US general population.”

More significant from that study, however, is that “suicide risk was not associated with a history of deployment to the war zone,” and “multiple deployments were not associated with the excess suicide risk among deployed veterans.” Which leads me to:

“22 a Day” fails to convey any nuances associated with suicide causes.
As active duty, retired, and separated combat veterans know, not all deployments are made equal. One soldier’s Korengal is another soldier’s Green Beans Coffee at Bagram.

“One soldier’s Korengal is another soldier’s Green Beans Coffee at Bagram.”

But civilians don’t have that experience. A veteran is a veteran to the general population and to many federal lawmakers as well. For that reason, efforts must be made to understand individual experiences and effectively engage with care tailored to each specific veteran.

As it turns out, Congress recently took a step in that direction.

A Foot Forward

As part of an amendment to the Consolidated Appropriations Act, 2016 signed into law last month, Congress ordered the Departments of Veteran Affairs and Defense to contract an independent third party “to carry out a study on the impact of participation in combat during service in the Armed Forces on suicides and other mental health issues among members of the Armed Forces and veterans.”

According to a New York Times article, Senator Michael Bennet introduced the amendment after reading the story of the suicide-plagued 2nd Battalion, 7th Marines. You can read about those Marines here. (Just a month ago, Tyler Schlagel became the 14th Marine from that battalion to take his life.)

2/7 Marines honor their fallen upon redeploying from Afghanistan in December 2008. The hard-hit battalion continues to lose members of its team. But seven years after returning home, suicide is the enemy. (Photo by Cpl. Margaret C. Hughes, via http://www.29palms.marines.mil/)

On another front, a new study is being conducted between the VA and CDC to fill in many of the gaps left unfilled by the 2012 report. The study is expected later this year and will help to define some of the details and sharpen the demographic breakdowns lacking from the previous report.

Value and Perspective

I don’t know if it’s possible to gauge the effect that “22 a Day” has had on veteran suicide prevention. I can’t be certain that 22 sets of 22 burpees hasn’t saved someone’s life, but it’s probable that the bumper sticker appeal and social media presence of this statistic has raised awareness and perhaps even encouraged more people to engage at-risk veterans and dissuade them from ending their lives.

That’s valuable, but is there a better way to look at these deeply troubling statistics that would more effectively address the problem, help to decrease veteran suicides, and improve the way officials make related policy and allocate funds?

“Approximately 1 in every 5 suicides in the US is a veteran.”

Perhaps more startling than “22 a day” is the fact that approximately 1 in every 5 suicides in the US is a veteran. That’s nearly 20% of all suicides. To put that into context, veterans only make up just under 7% of the total US population. “1 in 5” may not be as immediate as the average daily toll, but it paints a far more shocking picture of disproportion that demands answers and action.

Get Help, Give Help

Regardless of the accuracy or clarity behind the “22 a day” statistic, there is now a conversation about the troublesome frequency of veteran suicide, and that is a worthwhile discussion.

If you find yourself contemplating self-harm or planning on ending your life, please reach out to someone. Get help. You can also reach out to the Veterans Crisis Line by calling the number on the banner below and pressing “1” or by chatting with a person online by clicking the banner.

You can help someone out by being the battle buddy, friend, family member, or even complete stranger someone deserves in their moment of need. Sometimes all it takes is to ask, and quite often all it takes is for you to stop what you’re doing and value someone else’s time over your own.

Views expressed are those of the individual only and not those of the US Army or the Department of Defense.

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