Veterans Who Have Killed During War More Likely to Consider Suicide

Having killed someone during a war is strongly associated with suicidal ideation and should be considered when evaluating a veteran’s mental-health status, according to a recent study of Vietnam-era veterans.¹

Researchers at the San Francisco VAMC and the University of California, San Francisco, found that veterans with more experiences involving killing were twice as likely to have reported suicidal thoughts as veterans who had fewer or no experiences.

For the study, investigators created four variables:

• killing enemy combatants,
• killing prisoners,
• killing civilians in general and
• killing or injuring women, children or the elderly.

A single composite score was developed for each veteran, and researchers found that the higher the score, the greater the likelihood that a veteran had considered suicide.

That relationship held, even after adjusting for variables such as post-traumatic stress disorder (PTSD), depression, substance-use disorders and exposure to combat.

The VA-funded study, published electronically this past spring in the journal Depression and Anxiety, used data from the National Vietnam Veterans Readjustment Survey, a comprehensive study of a nationally representative sample of Vietnam-era veterans.

"The VA has a lot of very good mental-health programs, including programs targeting suicide prevention. Our goal is to make those programs even stronger," said lead author Shira Maguen, a clinical psychologist at the San Francisco VAMC and an assistant clinical professor of psychiatry at the University of California, San Francisco, campus. "We want clinicians and suicide-prevention coordinators to be aware that in analyzing a veteran's risk of suicide, killing in combat is an additional factor that they may or may not be aware of."

The only variable with a significant link to actual suicide attempts was PTSD; therefore, the link between having killed someone and suicide attempts was not as significant as the link between having killed someone and suicidal thoughts.

Maguen noted in a university press release that the mental-health impact of killing is neither formally evaluated as part of VA or DoD mental-health treatments nor usually considered when assessing suicide risk.

"We know from our previous research how hard it is to talk about killing," she noted. "It's important that we as care providers have these conversations with veterans in a supportive, therapeutic environment, so that they will feel comfortable talking about their experiences."

The authors concluded, “Killing experiences are not routinely examined when assessing suicide risk. Our findings have important implications for conducting suicide risk assessments in veterans of war.”

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1.    Maguen S, Metzler TJ, Bosch J, Marmar CR, Knight SJ, Neylan TC. Killing in
Combat May Be Independently Associated with Suicidal Ideation. Depress Anxiety.
2012 Apr 13. doi: 10.1002/da.21954. [Epub ahead of print] PubMed PMID: 22505038.