4 Ways Modern Medicine Is Helping Ease the Veteran Suicide Crisis

Hope for easing the suicide crisis among U.S. military veterans has grown in recent years, thanks in part to advances in treatments for post-traumatic stress disorder (PTSD), depression, and other mental health conditions veterans bring home from the battlefield.

That’s important news, because the number of veterans who die by suicide is sobering.

According to the U.S. Department of Veterans Affairs (the VA), nearly 20 military veterans die by suicide each day. That’s double the rate of their civilian peers.¹

The most common suicide risk factors for veterans include:

• A limited social environment — some remain unmarried or become homeless
• Access to and knowledge of firearms
• Development of medical and mental health conditions associated with suicide²

These mental health concerns, including depression and anxiety, affect millions of vets. In fact, the depression rate among vets is five times higher than that of civilians, according to one study published in the Journal of the American Medical Association Psychiatry.³

It’s a daunting problem for both patients and their providers. But progress — and healing — is possible. Here’s a look at some of the strategies doctors are using to help veterans recover.

New types of therapy can treat PTSD

Though post-traumatic stress disorder (PTSD) is often associated with war, it’s characterized by any long-lasting and intrusive reaction to a traumatic or frightening event. Sexual or physical assault, serious injury, and even dealing with a natural disaster can trigger PTSD. If you experience symptoms for longer than a month or if they interfere with your daily life, you may have PTSD.⁴

Clinicians now have a whole range of PTSD treatments that may help reduce the risk of death by suicide among veterans. A few of the most effective treatments include:

• Trauma-focused psychotherapy. Treatment focuses on the memory of the traumatic event or its meaning. The strategies include everything from visualization and talking through the trauma to simply thinking about the traumatic memory.⁴
• Prolonged exposure (PE). The goal of this type of therapy is to help you gain control of your emotions by facing your negative feelings. It involves talking about your trauma with a clinician and reengaging in some of the things you’ve put off since it occurred.⁵
• Cognitive processing therapy (CPT). This approach reframes your negative thoughts about the trauma. You’ll talk with your clinician about your thinking patterns and do short writing assignments.⁶
• Eye movement desensitization and reprocessing (EMDR). This strategy helps you process and make sense of your trauma. It also involves bringing the trauma to mind while paying attention to a movement or sound pattern (such as a light or tone).⁷

Strides are also being made to treat traumatic brain injury (TBI)

Along with living through the trauma of combat, the negative effects of a traumatic brain injury (TBI) may also contribute to the onset of mental health disorders among military veterans.⁸

One study found that veterans who served in Iraq and Afghanistan and suffered multiple traumatic brain injuries were nearly twice as likely to report suicidal thoughts as vets with just one TBI or none.⁹

One team of researchers, in cooperation with the VA San Diego Healthcare System, is using data from a national VA research program to investigate whether genes play a part in cognitive and psychiatric outcomes among vets with TBI histories.¹⁰

Like veterans who suffer from PTSD, treatment for TBIs can include a mixture of cognitive, physical, speech, and occupational therapy, along with medication to control symptoms such as headaches or anxiety.⁸

Precision medicine and veterans’ mental health

Another way doctors are treating mental health disorders among vets is through precision medicine.¹¹ This type of treatment plan factors in your genetic makeup, lifestyle, and environment, hence the “precision” in the name.¹²

What is one of the biggest advantages of a precision medicine approach? The ability to test your genes for the likelihood of potentially dangerous drug reactions or drug interactions.¹³ Among the hundreds of gene-drug pair interactions the U.S. Food and Drug Administration has identified,¹⁴ several include antidepressants and antipsychotics used to treat mental health disorders like depression, anxiety, and PTSD.

The FDA provides genetic-based warnings or dosage guidance on several mental health medications to avoid risk of serious adverse effects and death. For example, the dose of aripiprazole can vary by 8-fold depending in genetic makeup and concomitant medications.¹⁵

Precision medicine’s role in weeding out drug-drug and gene-drug interactions

Another benefit of precision medicine is that it takes into account the entire treatment picture: including other medications you take. This is important because you may also be susceptible to something called a drug-drug interaction. This happens when one medication affects the efficacy of another that you’ve taken at the same time, or the way your body metabolizes one or more medications. Either case can lead to a potentially harmful reaction.

Through pharmacogenomic (PGx) tests, which are conducted by companies such as Genomind, clinicians can discover whether you’re vulnerable to certain drug-gene or drug-drug interactions. And knowing this information up front — before you take even one pill — can lead to more positive outcomes.

Precision medicine techniques have also been deployed in veteran treatment, as is noted by Magali Haas, M.D. She’s the CEO and president of Cohen Veterans Bioscience in New York City. It’s a nonprofit working to better diagnose PTSD among military veterans and drive down the suicide rate. “The promise of precision medicine is that it will enable experts to treat people suffering from PTSD or TBI with an intervention most likely to benefit them,” says Haas.

There’s evidence to support this too: In one study conducted through the VA, clinicians who had access to Genomind’s PGx testing results and precision medicine software were able to effectively change their patients’ medication choices in 83% of the cases. Additionally, 55% of patients who were veterans saw their mental health improve following PGx-guided treatment.

Veterans’ mental health is a national priority

In 2020, the VA began implementing more mental health and suicide prevention services for veterans and their families, thanks to the passage of the Commander John Scott Hannon Veterans Mental Health Care Improvement Act (or the Hannon Act).¹⁶ Named for a decorated veteran who died by suicide in 2018, the act focuses on both community-based prevention strategies and clinical interventions.

This will include, in part, a precision medicine initiative by the VA to identify and validate brain and mental health biomarkers among veterans, with specific consideration for mental health conditions, including depression, PTSD, and TBI.¹⁷

The goal of the Hannon Act is to reduce vet suicides and increase resilience for those dealing with PTSD and TBI, especially in underserved areas. A key provision of this act is to ensure that the medical research community develops more individualized and precise PTSD and TBI therapies faster.

Dr. Haas believes that a greater investment in precision medicine practices among the scientific community will only lead to better treatment for military veterans. Because PTSD and TBI are both major risk factors for suicide, Dr. Haas concludes that doctors will be able to better address this “national crisis.”

If you’re experiencing suicidal thoughts right now—or know someone who is—you can contact the National Suicide Prevention Lifeline 24 hours a day, 7 days a week at 1-800-273-8255.

Sources:

1. Stats on veteran suicide rate: Mental Health (2021)
2. Risk factors for veterans: Suicide risk factors among veterans: risk management in the changing culture of the Department of Veterans Affairs (1997)
3. Depression rate five times higher: Thirty-Day Prevalence of DSM-IV Mental Disorders Among Nondeployed Soldiers in the US Army (2014)
4. Definition of PTSD: What Is Posttraumatic Stress Disorder? (2020)
5. Info on prolonged exposure: Prolonged Exposure for PTSD (2020)
6. Info on cognitive processing therapy: Cognitive Processing Therapy for PTSD (2020)
7. Info on EMDR: Eye Movement Desensitization and Reprocessing (EMDR) for PTSD (2020)
8. Info on TBI and mental health disorders: VA Research on Traumatic Brain Injury (TBI) (2022)
9. Study on TBIs: Study: Veterans with multiple brain injuries twice as likely to consider suicide, compared with those with one or none (2018)
10. TBI research study: Examination of Biological Markers Associated with Neurobehavioral and Neuropsychological Outcomes in Military Veterans with a History of Traumatic Brain Injury (2019)
11. Precision medicine being used with vets: Precision Medicine in Mental Health Care (PRIME Care): Incorporating Implementation Science into a Large Scale RCT (2018)
12. Info on precision medicine: What is precision medicine? (2020)
13. Info on pharmacogenomic testing: Pharmacogenetic Tests (2021)
14. More than 300 medications that have drug-gene interactions: Table of Pharmacogenomic Biomarkers in Drug Labeling (2021)
15. Info on aripiprazole dosage: Abilify (2014)
16. Info on the Hannon Act: Cdr. Hannon legislation advances mental health care (2021)
17. Info on precision medicine in the Hannon Act: Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 (2020)