Rate, not just number, helps explain vet suicide risk

Georgia’s senior U.S. senator took control of the U.S. Senate Veteran Affairs Committee in January, and within a month, had bipartisan support for a bill aimed at improving mental health care for veterans.

Johnny Isakson noted the broad support for the Clay Hunt Suicide Prevention For American Veterans Act in an Associated Press article just days before it cleared the Senate and headed to President Barack Obama’s desk.

"When you have 8,000 veterans a year committing suicide, then you have a serious problem," Isakson said.

That statistic – based on the math that an average of 22 military veterans take their lives every day – is often repeated by the same broad groups. The AP story that quotes Isakson also cites it.

But just how accurate is the figure? PolitiFact Georgia already tackled the problems with the figure in a fact check about "solider suicides" made by Democratic Congressman David Scott, who represents part of metro Atlanta.

Now that the bill is law, the government will repay student loans for psychiatrists who join the Department of Veterans Affairs and also will develop peer support groups and community outreach with veterans’ service groups. So what about those veterans?

The figures in question come from a U.S. Department of Veterans Affairs report released in 2013, based on the most extensive data the agency has collected on veterans’ suicide.

The study examined death certificates in 21 states, to conclude that veterans accounted for 22 percent of suicides.

Applying that percentage to about 38,000 suicides in the United States annually that translates to about 8,300 veteran suicides, or 22 a day.

However, it’s important to acknowledge the study looked only at 21 states. Georgia was not among them.

The death certificates themselves also were imprecise. The report itself acknowledges that about 5 percent of a sub-group of the sample were misidentified as veterans or non-veterans, when checked against VA records.

In other words, the figures are an estimate. Although the study was the first analysis of its kind, it does not offer an actual count of the number of veterans who take their own lives.

A study published this month does finally offer a specific number, at least for recent veterans.

The study published in the February issue of Annals of Epidemiology matched military records of nearly 1.3 million active-duty veterans who served between 2001 and 2007 with the National Death Index.

It found 1,868 suicides through the end of 2009. That translates into a rate of one suicide per day for that specific group of recent veterans.

So which is accurate -- estimates of 22 suicides daily among all veterans or 1 a day for recent vets?

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Most likely, both, said Michael Schoenbaum, an epidemiologist who specializes in military suicides at the National Institute of Mental Health.

Not that either number matters, without a frame of reference. And that’s where it gets tricky.

Schoenbaum points out 22 or 1 are simply numbers. Their significance is meaningless, until they are applied to how they stack up against comparable non-veterans suicides.

There, the data is far more clear. Suicide is the 10th most common cause of death in the United States, with a rate of 12.6 deaths per 100,000 people, according to the National Center for Health Statistics.

Both studies, the estimate for all veterans and the actual count of recent veterans, show a much higher rate for veterans.

The VA study shows a rate that is 20 percent higher than the civilian population. The most recent study is even more alarming, showing a 50 percent higher rate, with 29.5 deaths per 100,000 veterans.

"To say 22 veterans a day, 8,000 veterans a year, commit suicide, it’s a defensible statistic," Schoenbaum said.

"When people ask me about suicide risk in veterans, I don’t talk about that. I talk about rates," he continued. "The general insight there is yes, there is something about the veteran population that is leading them to have higher rates of suicide than other people. And I believe we have a national obligation to help them."

Isakson said he knew of "shortcomings" in the VA data but said the estimates were the best available when he spoke during committee hearings.

He made the issue a priority when he took over the committee, he said, because of the need for more attention and information on the issue.

"The intent is to have a number that can reflect that this is an alarming rate, and we must address it, given our obligation to all veterans," Isakson said.

The $22 million in funding is designed to pay that debt, as federal agencies work to compile more accurate data.

The VA is working with the Department of Defense, to assemble the Suicide Data Repository, Schoenbaum said. Like the latest study, it will pair death records to military and healthcare records, but for all veterans.

"The reason to do these calculations, to track this data, is to first see if there is a problem. Now we know, there is," he said. "The next step is to process where it is. Who is at risk? Why? That requires more data that we don’t yet have."

And the information we do have? Isakson said 8,000 veterans are taking their own lives every year.

The number comes from a VA study that is statistically reliable, if somewhat lacking context.

It is the context that matters here. The number fails to impart the fact that research shows veterans commit suicide at a higher, perhaps much higher, rate than their civilian counterparts.

Isakson was correct on the numbers. But there is a bit of context missing in what those numbers mean.

We rate Isakson's statement Mostly True.