The figure, released by the Department of Veterans Affairs
in February, is based on the agency's own data and numbers reported by
21 states from 1999 through 2011. Those states represent about 40% of
the U.S. population. The other states, including the two largest
(California and Texas) and the fifth-largest (Illinois), did not make
data available.
Who wasn't counted?
People like Levi Derby,
who hanged himself in his grandfather's garage in Illinois on April 5,
2007. He was haunted, says his mother, Judy Caspar, by an Afghan child's
death. He had handed the girl a bottle of water, and when she came
forward to take it, she stepped on a land mine.
When Derby returned home,
he locked himself in a motel room for days. Caspar saw a vacant stare
in her son's eyes. A while later, Derby was called up for a tour of
Iraq. He didn't want to kill again. He went AWOL and finally agreed to a
dishonorable discharge.
Derby was not in the VA system, and Illinois did not send in data on veteran suicides to the VA.
Experts have no doubt
that people are being missed in the national counting of veteran
suicides. Luana Ritch, the veterans and military families coordinator in
Nevada, helped publish an extensive report on that state's veteran
suicides.
Part of the problem, she
says, is that there is no uniform reporting system for deaths in
America. It's usually up to a funeral director or a coroner to enter
veteran status and suicide on a death certificate. Veteran status is a
single question on the death report, and there is no verification of it
from the Defense Department or the VA.
"Birth and death
certificates are only as good as the information that is entered," Ritch
says. "There is underreporting. How much, I don't know."
Who else might not be counted?
A homeless person who
has no one who can vouch that he or she is a veteran, or others whose
families don't want to divulge a suicide because of the stigma
associated with mental illness; they may pressure a state coroner to not
list the death as suicide
If a veteran
intentionally crashes a car or dies of a drug overdose and leaves no
note, that death may not be counted as suicide.
An investigation by the Austin American-Statesman newspaper last
year revealed an alarmingly high percentage of veterans who died in
this manner in Texas, a state that did not send in data for the VA
report.
"It's very hard to capture that information," says Barbara van Dahlen, a psychologist who founded Give an Hour, a nonprofit group that pairs volunteer mental-health professionals with combat veterans.
Nikkolas Lookabill had
been home about four months from Iraq when he was shot to death by
police in Vancouver, Washington, in September 2010. The prosecutor's
office said Lookabill told officers "he wanted them to shoot him." The
case is one of many considered "suicide by cop" and not counted in
suicide data.
Carri Leigh Goodwin
enlisted in the Marine Corps in 2007. She said she was raped by a fellow
Marine at Camp Pendleton and eventually was forced out of the Corps
with a personality disorder diagnosis. She did not tell her family that
she was raped or that she had thought about suicide. She also did not
tell them she was taking Zoloft, a drug prescribed for anxiety.
Her father, Gary Noling,
noticed that Goodwin was drinking heavily when she returned home. Five
days later, she went drinking with her sister, who left her intoxicated
in a parked car. The Zoloft interacted with the alcohol, and she died in
the back seat of the car. Her blood alcohol content was six times the
legal limit.
Police charged her
sister and a friend in Goodwin's death for furnishing alcohol to an
underaged woman: Goodwin was 20. Noling says his daughter intended to
drink herself to death. Later, Noling went through Goodwin's journals
and learned about her rape and suicidal thoughts.
A recent analysis by News21,
an investigative multimedia program for journalism students, found that
the annual suicide rate among veterans is about 30 for every 100,000 of
the population, compared with the civilian rate of 14 per 100,000. The
analysis of records from 48 states found that the suicide rate for
veterans increased an average of 2.6% a year from 2005 to 2011 -- more
than double the rate of increase for civilian suicide.
Nearly one in five
suicides nationally is a veteran, even though veterans make up about 10%
of the U.S. population, the News21 analysis found.
The authors of the VA
study, Janet Kemp and Robert Bossarte, included many cautions about the
interpretation of their data, though they stand by the reliability of
their findings. Bossarte said there was a consistency in the samples
that allowed them to comfortably project the national figure of 22.
But more than 34,000
suicides from the 21 states that reported data to the VA were discarded
because the state death records failed to indicate whether the deceased
was a veteran. That's 23% of the recorded suicides from those states. So
the study looked at 77% of the recorded suicides in 40% of the U.S.
population.
The VA report itself
acknowledged "significant limitations" of the available data and
identified flaws in its report. "The ability of death certificates to
fully capture female veterans was particularly low; only 67% of true
female veterans were identified. Younger or unmarried veterans and those
with lower levels of education were also more likely to be missed on
the death certificate."
"We think that all
suicides are underreported. There is uncertainty in the check box," says
Steve Elkins, the state registrar in Minnesota, which has one of the
best suicide data recording systems in the country.
VA Secretary Eric
Shinseki requested collaboration from all 50 states to improve
timeliness and accuracy of suicide reporting, key to improving suicide
prevention. At the time the VA released its last suicide report, at
least 11 states had not made a decision on data collaboration.
Combat stress is just
one reason why veterans attempt suicide. Military sexual assaults are
another. Psychologist Craig Bryan says his research is finding that
military victims of violent assault or rape are six times more likely to
attempt suicide than military non-victims.
More than 69% of all
veteran suicides were among those 50 and older. Mental-health
professionals said one reason could be that these men give up on life
after their children are out of the house or a longtime marriage falls
apart. They are also likely to be Vietnam veterans, who returned from
war to a hostile public and an unresponsive VA. Combat stress was
chalked up to being crazy, and many Vietnam veterans lived with ghosts
in their heads without seeking help.
Even though more older
veterans are committing suicide, it's difficult to predict what the toll
of America's newest wars will be. A survey by the Iraq and Afghanistan Veterans of America showed
that 30% of service members have considered taking their own life, and
45% said they know an Iraq or Afghanistan veteran who has attempted
suicide.
"There's probably a tidal wave of suicides coming," says Brian Kinsella, an Iraq war veteran who started Stop Soldier Suicide,
a nonprofit group that works to raise awareness of suicide. Between
October 2006 and June 2013, the Veterans Crisis Line received more than
890,000 calls. That number does not include chats and texts.
President Barack Obama
says there is a need to "end this epidemic of suicide among our veterans
and troops." In August 2012, he signed an executive order calling for
stronger suicide prevention efforts. A year later, he announced $107
million in new funding for better mental health treatment for veterans
with post-traumatic stress and traumatic brain injury, signature
injuries of the wars in Afghanistan and Iraq.
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