You may have read that approximately 18 U.S. military veterans die by suicide each day. You may have heard about the Veteran’s Crisis Line, which offers crisis support 24 hours a day, for veterans and their loved ones. What you have probably heard less about is how you can help a veteran before circumstances escalate to a crisis.
Despite advancements in suicide prevention, veterans continue to have a 1.5-times increased risk of suicide compared to non-veterans (Ruiz et al., 2023). A key challenge for suicide prevention is that it requires intervention at many levels. There is no miracle cure or simple lever to pull that will make everything better. Efforts must occur at the individual, familial, cultural, healthcare, and workplace levels: It takes a village to save a life.
Does this sound like an impossible task? Maybe. But it is a necessary, worthwhile mission. Each veteran who dies by suicide is a tragedy. So, how can we fulfill this mission? How can we meaningfully reduce suicide across a broad, diverse population like veterans?
Address the Deadly Gap for Transitioning Service Members
In the last decade, researchers have discovered a strategic period for intervention: the “deadly gap” (Sokol et al., 2021). This refers to the first year after veterans transition out of military service, when they experience a spike in suicide risk. In a study of 3.8 million service members between 2001-2011, the risk of suicide almost tripled in the first year of separation from the military (Shen et al., 2016). Unfortunately, we continue to observe similar trends today.
According to the most recent data from the Department of Veteran Affairs, the suicide rate for transitioning veterans has decreased somewhat but remains high. In 2023, the suicide rate for the general population was 14.2 per 100,000, meaning that about 14 people in this demographic died by suicide for every 100,000 people. Among all veterans, the suicide rate was 35.2 per 100,000. If we zoom in on transitioning veterans, the rate was 41.2 per 100,000. If we zoom in even further, on veterans who recently separated with a substance use disorder, the rate is 152.6 per 100,000.
This raises the question: Why does the deadly gap exist?
Background of a Leading Theory for Suicide
The Three-Step Theory of Suicide can help us understand this vulnerable period for military members. This theory, developed by Klonsky and colleagues (2021), helps us organize the mental and social processes that lead someone from having suicidal thoughts to making a suicide attempt.
Step 1 proposes that people are likely to develop suicidal thoughts when they experience pain (often psychological or emotional but also physical) and hopelessness about resolving the pain. For instance, a veteran with depression might experience intense emotional pain and feel like they will never get better (hopelessness).
Step 2 highlights the importance of social and community connections, as well as one’s identity, in moderating the intensity of suicidal ideation. For instance, disruptions in one’s social network—losing friends, a break-up, a death of a loved one—can cause further pain and make someone feel disconnected from life. When the pain exceeds someone’s connections to life, then their suicidal ideation is likely to worsen. That said, not everyone who has suicidal thoughts will make an attempt (Klonsky et al., 2016).
Step 3 notes that suicidal thoughts are more likely to escalate to a suicide attempt for people with “acquired capability.” This term captures a combination of personal factors (e.g., having a high pain tolerance, having an impulsive personality), acquired factors (e.g., being exposed to and feeling numb to death), and practical factors (e.g., having knowledge and access to lethal means).
Why the Deadly Gap Exists
With an understanding of the Three-Step Theory, let’s highlight three experiences of transitioning service members that increase their risk of suicide.
Disruptions in Healthcare. Transitioning veterans are, by definition, transitioning out of their careers in the military and into civilian lives. While veterans have access to the Department of Veteran Affairs (VA), they are not necessarily set up with these services immediately upon discharge. Additionally, about half of veterans do not use VA services.
It can take time for veterans to navigate the bureaucracy of the healthcare system – both in the public and private sectors. The situation is especially challenging for mental health. Finding a mental health provider can be a long, confusing, and frustrating process that may itself delay people’s willingness to seek care. Once veterans do establish with a healthcare system, there can be long waitlists to see a mental health provider (Feyman et al., 2022).
Put simply, disruptions in healthcare can be particularly harmful for a group that has extensive physical and mental health needs (Oster et al., 2017). The situation is especially difficult for veterans with conditions like major depression, post-traumatic stress disorder, substance use disorders, and suicidal thoughts, as they may feel hopeless while seeking help (Livingston et al., 2026; Markowitz et al., 2023).
Changes in Identity, Career, and Connections. Discharging from the military is an enormous life transition. A military career is defined by distinct norms, values, and expectations. Service members are embedded in a work culture defined by a shared mission, a clear hierarchy, and cohesiveness. Military values are characterized by themes of respect, honor, strength, and putting the mission above oneself. This culture can become a core part of a veteran’s identity. That environment is naturally where service members form lifelong bonds, friendships, and mentors. Unfortunately, transitioning out of the service creates distance from these relationships, which can make a veteran feel isolated and alone.
As a result, transitioning veterans may feel culture shock re-acclimating to civilian life. They may face existential questions like: Who am I? What should I be doing? What is my purpose, now? They may also feel misunderstood by non-veterans. In interview research, veterans often express that they feel “alienated” by family members and friends who cannot grasp the gravity of their military experiences (Ahern et al., 2015). As it relates to the Three-Step Theory, losses in a veteran’s career, identity, and social connectedness can be perfect storm for who already feels hopeless and in pain.
Capability for Suicide. “Acquired capability” is the last step of the Three-step Theory. Unfortunately, veterans have unique training, knowledge, and experiences that increase their capability to make a suicide attempt. For example, service members in the Army and Marines gain extensive training in firearms and, according to data from the VA, over 70% of veteran suicides involved the use of a firearm. Service members in the Navy are well-versed at tying knots (connected to hanging), and service members in the Air Force are de-sensitized to heights (connected to jumping). Knowing about these lethal means can help veterans, clinicians, family members, and friends to develop safe environments for high-risk veterans.
How We Can Help Transitioning Service Members
The deadly gap should not exist. But by understanding it in-depth, we can strategically work to improve veteran lives before their circumstances escalate to a crisis. Society needs to ease the burden of the transition experience for veterans. Healthcare systems need to become more efficient at bridging care for veterans by streamlining processes and hiring high quality providers. Family and friends can seek formal trainings about military culture to reduce the chance of making a veteran feel alienated. And people concerned about a veteran’s access to lethal means can seek out resources to help them engage in safety planning for suicide prevention.
The views expressed in this post are my own and do not necessarily reflect the views of the Department of Veterans Affairs (VA) or the United States Government. If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.