Which Veterans With Cancer Are Most Likely to Attempt Suicide?

Study Identifies Those Most at Risk and for How Long

PORTLAND, OR — In recent years, the conventional wisdom has been that patients at risk for suicide after being diagnosed with cancer usually were older white males with advanced or poor-prognosis cases. That doesn’t tell the whole story, however, according to a new study which includes both fatal and nonfatal suicide attempts among U.S. veterans.

Researchers led by Oregon Health & Science University and the VA Portland Healthcare System, both in Portland, sought to determine the longitudinal rates of suicidal self-directed violence (SSDV) among veterans with cancer and which characteristics are associated with the highest risk.

The cohort study of 292,271 veterans, published in JAMA Oncology, found that the overall rate of SSDV was 203 events per 100,000 person-years. Veteran subgroups having high rates of nonfatal attempts compared with the overall cohort were:

• Female
• 45 years old or younger
• American Indian or Alaska Native race and
• Patients with thyroid cancer especially but also those with cancers of the brain and central nervous system, pancreas, head and neck and liver.

The elevated risk persisted 5 years post-diagnosis for those who were younger, unmarried or had central nervous system cancer, according to the study team.¹

“These findings indicate that many veteran subgroups at risk for SSDV are overlooked, limiting opportunities for intervention,” the authors point out.

“Our findings really show that suicide risk doesn’t end when treatment ends,” explained lead author Donald R. Sullivan, MD, MA, associate professor of medicine in the OHSU School of Medicine and affiliate physician-scientist at the Portland VA. “For some patients, especially younger veterans and those with certain cancers, the risk remains elevated for years.”

For the study, the authors examined both fatal and nonfatal suicide attempts among veterans diagnosed with cancer between 2014 and 2023. They suggested that most previous studies have focused only on deaths by suicide, causing them to miss the far more common nonfatal attempts.

In fact, of the 2,400 suicide-related events identified, nearly 90% were nonfatal attempts. Overall, according to the study, veterans with cancer experienced suicide attempts at a rate of 203 per 100,000—significantly higher than the general population. The risk was found to be highest in the first 6 months after diagnosis but remained persistently elevated for up to 5 years.

“A cancer diagnosis is often a profound shock,” Sullivan said. “Even cancers with good survival rates can trigger an immediate fear of death. That initial moment, combined with pain, treatment side effects, anxiety or depression, can be incredibly destabilizing.”

He added, “Younger veterans really stood out. They may be dealing with careers, family responsibilities or financial stress on top of a cancer diagnosis. That combination can be overwhelming.”

Noting that patients with thyroid cancer, which often is considered a more treatable disease, also experienced notably higher rates of nonfatal attempts, Sullivan said that highlights the importance of screening all cancer patients, not only those with poor prognoses.

The study also determined that veterans with chronic mental illness, high pain levels or severe frailty were also among those at highest risk. The most common method used in nonfatal suicide attempts was prescription medications—including opioids, but firearms were used most often in the fatal attempts.

“These results reinforce the need for better support not just during treatment, but after treatment ends,” Sullivan said. “Survivorship often comes with lasting physical symptoms, emotional distress and fear of recurrence—and we don’t always do enough to address those challenges.”

The study findings also indicated that veterans who received palliative care—or specialized medical care for people with serious, complex or terminal illness—had lower rates of suicide-related events. That raised the possibility that early supportive services might help reduce risk,” the authors advised.

VA maintains a comprehensive suicide surveillance system, so researchers were able to identify patterns that are invisible in most other health systems, according to Sullivan, who added, “This kind of data simply doesn’t exist for nonveterans. But what we’re seeing here almost certainly applies beyond the VA.”

The authors recommended that routine suicide risk screening should begin at diagnosis and continue through survivorship and also should take into account individual risk factors such as age, cancer type, pain and mental health history.

Included in the study were 292,271 veterans with a mean age of 69, 98% male and 75% white. The researchers identified 2,400 SSDV events (1%; overall rate, 203 [95% CI, 195-211] per 100,000 person-years). The most common method used was poisoning, with opioids used in 26% of attempts.

The researchers reported that estimated SSDV probabilities were highest for those with central nervous system (CNS), pancreas, head and neck, liver and biliary system and thyroid cancer types. In addition, veterans with severe frailty (544 [95% CI, 457-648] events per 100,000 person-years), advanced cancer (261 [95% CI, 233-293] events per 100,000 person-years), chronic mental illness (419 [95% CI, 399-439] events per 100,000 person-years) and high pain scores (236 [95% CI, 192-210] events per 100,000 person-years) had high SSDV rates compared with the overall cohort.

They added that younger age (≤45 years; 643 [95% CI, 547-756] events per 100,000 person-years), female sex (369 [95% CI, 306-445] events per 100,000 person-years), American Indian or Alaska Native race (286 [95% CI, 201-407] events per 100,000 person-years) and CNS (394 [95% CI, 311-500] events per 100,000 person-years) and thyroid (359 [95% CI, 290-445] events per 100,000 person-years) cancers had high rates of nonfatal attempts. Increased SSDV hazards (6 months post-diagnosis) occurred among veterans of Asian compared with white race (aHR, 2.55; 95% CI, 1.12-5.76), unmarried veterans (aHR, 1.83; 95% CI, 1.47-2.27), veterans with CNS (aHR, 2.07; 95% CI, 1.13-3.80) or head and neck (aHR, 1.67; 95% CI, 1.13-2.48) compared with lung cancer and veterans with advanced cancer (aHR, 1.30; 95% CI, 1.00-1.68).

“Risk for most veterans decreased over time after diagnosis; however, risk remained elevated 5 years post-diagnosis for younger veterans (aged ≤45 vs 46-64 years; aHR, 1.58; 95% CI, 1.29-1.94), unmarried veterans (aHR, 1.48; 95% CI, 1.35-1.62), veterans with CNS vs. lung cancer (aHR, 1.63; 95% CI, 1.22-1.27) and veterans with advanced cancer (aHR, 1.30; 95% CI, 1.14-1.50),” according to the results.

“Previously overlooked high risk, subgroups, such as younger veterans, Asian veterans or veterans with thyroid cancer, stress the need to systematically track all suicidal behaviors, not just fatal attempts, to inform tailored screening and prevention strategies as a key component of cancer care,” the authors advised.

“As the incidence and prevalence of cancer increases,” they added, “understanding suicide risk is increasingly important. Understanding risk, particularly among younger patients, and monitoring risk years into survivorship are essential because some cancer types are increasing among individuals younger than 50 years (eg, colorectal), and treatment advances have increased survivorship.”

“Every care provider can help veterans who are struggling with the burden of both cancer and suicidal ideation. This study provides important insights into how caregivers can provide critically needed mental health support to veterans,” said OHSU President Shereef Elnahal, MD, MBA. “In my time as undersecretary for health in the VA, preventing veteran suicides was our top clinical priority, and it should continue to be a focal point for veteran care.”

1. Sullivan DR, Disher N, Rosa WE, et al.Longitudinal Risk for Suicidal Self-Directed Violence Among Veterans With Cancer.  JAMA Oncol. Published online May 28, 2026. doi:10.1001/jamaoncol.2026.1459