Click to Enlarge: Predicted Probabilities of Suicide-Related Measures by Adverse Social Determinants of Health (SDOH) Composite Factor Scores and Adverse SDOH Composite Scores and Lifetime Psychiatric HistoryValues on the x-axis represent ventiles (5-percentile groups) of the composite SDOH scores. Dashed horizontal lines indicate the mean predicted probability of each suicide-related measure across the full sample: past-year suicidal ideation = 0.119, future suicidal intent = 0.014, and lifetime suicide attempt = 0.039. Probabilities are adjusted for age, sex, race and ethnicity, marital/partnered status, combat veteran status, years of military service, lifetime psychiatric diagnoses (including major depressive disorder, posttraumatic stress disorder, and alcohol or drug use disorders), and number of physical health conditions. Source: JAMA Network
WEST HAVEN, CT — Suicide is a pressing public health challenge in the United States, and veterans bear a disproportionate share of this burden. Although they represent less than 7% of the U.S. adult population, veterans account for about 14% of suicide deaths nationwide.
Researchers have long recognized the roles of trauma exposure, psychiatric disorders and barriers to care in driving this elevated risk. A new study added important insight by showing that social determinants of health—the everyday conditions that shape people’s lives—are strongly linked to suicidal thoughts and behaviors among U.S. veterans, particularly when multiple disadvantages accumulate.
“We became increasingly aware many veterans experiencing suicidal thoughts or behaviors were also facing substantial social adversity,” said Robert H. Pietrzak, PhD, MPH, research psychologist in the Clinical Neurosciences Division at the VA National Center for PTSD. “Prior research has often examined individual social factors in isolation, but we sought to better understand how the combined burden of multiple adverse social determinants of health (SDoH) contribute to suicide risk among veterans, beyond well-established clinical predictors like psychiatric disorders.”
Pietrzak and his colleagues analyzed data from the National Health and Resilience in Veterans Study, a nationally representative survey of 4,069 U.S. veterans, including individuals both engaged and not engaged in VA health care.1
“Using 21 indicators from Healthy People 2030 and related social determinants of health frameworks, we developed a composite measure spanning five key domains: economic conditions, trauma burden, health care access, neighborhood environment, and social context,” he said.
Rather than focusing on suicide deaths—which are relatively rare in cohort studies—the researchers examined suicidal thoughts and behaviors (STBs), including past-year suicidal ideation, lifetime suicide attempts and future suicidal intent. These outcomes are widely used as validated indicators of suicide risk.
The results, published in JAMA Psychiatry, revealed a strong, graded relationship between cumulative social disadvantage and suicide risk.1
“Even after adjusting for a wide range of demographic, military and health-related factors, each standard deviation increase in SDoH burden was linked to more than double the odds of past-year suicidal ideations and future suicidal intent, as well as over 70% higher odds of lifetime suicide attempts,” Pietrzak said.
The most extreme disparities were seen at the highest levels of social adversity. “Veterans in the highest 5% of SDoH burden were more than 20 times more likely to report suicidal thoughts or behaviors compared with those in the lowest 5%,” Pietrzak noted. “These associations were especially pronounced among veterans with a history of psychiatric diagnoses.”
Pietrzak, who called the magnitude and consistency of the findings were “striking,” said that, “Even after accounting for demographic, military and clinical factors, the cumulative impact of social disadvantage emerged as a powerful predictor of suicidal thoughts and behaviors.”
The findings suggest that social adversity might compound existing vulnerabilities, particularly among veterans with mental health conditions. Housing instability, financial strain, limited access to care, trauma exposure and social isolation can heighten stress while simultaneously reducing access to protective resources.
Historically, suicide prevention efforts within the VA and other systems have focused largely on mental health treatment and crisis intervention. While these approaches remain critical, the study suggests they might be insufficient on their own.
“These results suggest that suicide prevention cannot rely solely on clinical interventions or crisis response,” Pietrzak said. “Addressing upstream social risk factors, such as housing instability, financial strain, limited access to care, trauma burden, and social isolation, may be essential components of a comprehensive prevention strategy.”
Routine screening for adverse social determinants in VA and community settings could help identify veterans at elevated risk earlier and facilitate referrals to social and supportive services. At the policy level, investments in housing, trauma-informed care, mental health infrastructure and programs that strengthen social connection might help reduce suicide risk before a crisis emerges.
For clinicians working with veterans, “the key message is that social conditions matter profoundly for suicide risk among veterans,” Pietrzak told U.S. Medicine. “Those experiencing multiple social disadvantages are at exceptionally high risk, even beyond traditional clinical indicators.”
- Pietrzak RH, Fischer IC, Nichter B, Esterlis I, Krystal JH, Moutier CY, Oquendo MA, Jeste DV, Na PJ. Social Determinants of Health and Suicide Risk in US Military Veterans. JAMA Psychiatry. 2025 Dec 23:e253883. doi: 10.1001/jamapsychiatry.2025.3883. Epub ahead of print. PMID: 41432940; PMCID: PMC12728726.
