Suicidal behavior in military veterans and health care professionals

To the Editor

Multiple lines of evidence suggest that the risk of suicide is significantly increased in military veterans and health care professionals. For example, during the fiscal year 2000/2001 (i.e. before the Afghanistan and Iraq wars), suicide rates were two times higher among patients receiving care from the US Veterans Health Administration compared to the general US population (McCarthy et al., 2009). A review of international studies of suicide in physicians found higher rates of suicide in physicians compared with the general population (Lindeman et al., 1996). The relative risks ranged from 1.1 to 3.4 in male physicians and from 2.5 to 5.7 in female physicians.

It is interesting and important to note that there are some significant similarities between these two population groups.

1. Stigma attached to mental illness among military veterans and among health care professionals leads to denial and delays in care seeking, resulting in unnecessary suffering, self-medication/substance abuse, and self-isolation. This indicates that it is imperative to reduce the stigma of psychiatric illness among both military veterans and medical professionals. Unfortunately, the culture of medicine gives low priority to physician and nurse mental health, despite evidence of an increased burden of suicide.

2. Both military veterans and medical professionals know how to use lethal means. Veterans know how to kill themselves using guns. Health care workers know how to commit suicide using medications. Therefore, suicide prevention strategies in veterans and medical professionals should include timely and appropriate screening for suicidal ideation. If suicidal ideation is present, any access to lethal means should be restricted.

3. According to the Interpersonal-Psychological Theory of Suicide, the suicidal process is related to feelings that one does not belong with other people, feelings that one is a burden on others or society, and an acquired capability to overcome the fear of pain associated with suicide (Selby et al., 2010). Veterans are likely to have acquired this capability as a result of military training and combat exposure, which may cause habituation to fear of painful experiences, including suicide. It is reasonable to suggest that physicians and nurses may also acquire this ability as a result of their professional training.

Prevention and treatment of suicidal behavior in military veterans and health care professionals should be informed by our knowledge of the psychological and biological features of suicidal behavior in these unique patient populations.