“Vets are good at camaraderie and connecting, but we’re terrible at helping each other,” he said. “Through this annual walk, we connect with community and create awareness by bringing vets together. We want to create the feeling that vets are not alone.” 

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Trend reversal 

Historically, the suicide rate among active duty service members and veterans has been about 20 to 30 percent lower than among the U.S. civilian population. That was a benefit of what’s known as the Healthy Soldier Effect. The rigorous screening processes required to enter the U.S. Armed Forces, combined with a structured fitness-oriented lifestyle, tight-knit community and access to regular healthcare, produced a military that had a lower rate of death from all causes when compared with the civilian population. 

But with the post-9/11 wars in Afghanistan and Iraq, which spanned 2001 to 2021, veteran suicide rates started to rise, outpacing the general population by 41 percent  to 61 percent. Suicide rates spiked in 2007, in 2008 and again in 2018, which turned out to be the deadliest year in the last two decades with 6,722 deaths.

Since 2001, 140,436 veterans have died by suicide, according to the 2024 National Veteran Suicide Prevention Annual Report, published by the U.S. Department of Veterans Affairs (VA).

Some researchers believe the number of deaths could be higher still because suicide can be tricky to classify and because what is defined as “veteran suicide,” which the VA revised from 22 to 17 deaths per day, is narrowly categorized, according to Robert Bossarte, PhD, professor of psychiatry at the University of South Florida in Tampa. 

“That 17 number uses the strict definition of veteran according to legislative classification,” Bossarte said. “It doesn't count people, for example, who are in the National Guard or reserves who were not activated. So if you include anybody who had any uniform service, that number will go up quite a bit.” 

There’s no indication the trend will reverse itself, according to John Blosnich, PhD, MPH, associate professor of public health at the University of Southern California in Los Angeles.

Suicide has slowly been increasing in the United States for the past 25 years, he explained in an interview with VoxPopuli. “Veterans are kind of on the crest of that,” he said, adding that veteran demographics line up with the groups that have the highest risk for suicide: older white men with easy access to firearms. 

“When someone is in a period of distress and they are on a path to end their life, if they have a firearm or they don’t have a firearm, that decision-tree point defines whether they’re going to die, typically if they have access to a firearm in America,” Blosnich said.  

Guns are used in nearly 75 percent of veteran suicides. A 2019 study published in JAMA found that storing a loaded gun at home and carrying a gun when not on duty quadrupled the odds of suicide death. The VA recognizes that firearms are a problem. Last year, it launched a pilot program that offers free gun lockboxes to veterans who are at an elevated risk for suicide, as diagnosed by medical professionals.

“It’s not whether people should have guns or not, but the level of safety around those guns so that they're not in arm's reach when somebody is feeling impulsively suicidal,” said Sonja Batten, PhD, chief clinical officer at Stop Soldier Suicide and Roger Wellness Service, which provides licensed telehealth counseling and crisis intervention in Florida and 19 other states. 

Florida, with its expansive gun laws and 1.4 million veterans, is second only to Texas in veteran suicides, according to the VA. The national suicide rate among veterans is 1.5 times higher than for civilians. But in the Sunshine State, veterans die by suicide at a rate that is 2.6 times higher than the general population. Florida lost 540 veterans to suicide in 2022, the most recent year for which statistics are available. More than 200 were over 55.  

The question is why? Why do some soldiers make it out of the theater of war and get all the way home only to take their own lives? Why do other veterans who have never seen combat make that same choice? 

Trio of symptoms 

Larry Wilson, a 54-year-old retired Marine veteran, received help for his PTSD three years ago after he was sidelined following knee surgery. The Windermere resident enlisted at 19, following his grandfather, who served in WWII, and his father and uncle, who served in Vietnam. Wilson spent eight years in the Marines during the Persian Gulf War, worked as an Atlanta police officer and is now employed in diplomatic security at the U.S. Embassy in Israel.

Combat exposure, training accidents and sexual assault can all cause PTSD or post-traumatic stress disorder, which can lead to flashbacks, emotional numbness, sleep disturbances and difficulties with concentration. Research shows a clear link between PTSD and elevated suicide risk. A 2011 study of combat veterans from the Iraq and Afghanistan wars found that veterans with PTSD were three times more likely to report hopelessness and suicidal thoughts than those without PTSD.

A variety of incidents trigger Wilson’s PTSD. A car backfiring reminded him of explosions. The smell of barbecuing brought back the scent of burnt flesh that he experienced during combat. His knee injury made him wonder if his military career was over, adding that he felt isolated. His identity was tied to his military service.

“Most civilians don’t get it,” Wilson said in an interview. “The pressures of life build up, and something may trigger you to traumatic experiences that happened during contact with the enemy — horrifying things that an 18- or 19-year-old kid should never see.”

Wilson said he was fortunate to have time off work to file paperwork that led to a year of VA counseling, which taught him how to deal with the triggers. 

“It’s a pain in the butt to go through the VA bureaucracy and red tape,” he said.

Damon Friedman, a retired U.S. Air Force lieutenant colonel, served four combat tours in Iraq and Afghanistan. The 51-year-old from Tampa said he understands why people take their own lives because he’s been to that dark place.

“I personally understand the struggles of bringing the war home,” said Friedman, who added that he experienced suicidal thoughts following a mild traumatic brain injury that caused vertigo, dizziness, difficulty sleeping and concentrating.

Friedman said he was overwhelmed with nightmares, flashbacks, anxiety and depression while serving in Afghanistan in 2011 and 2012. 

“My back, neck and knee hurt from rucking,” Friedman said. “I had so much pain and I isolated myself. I didn’t understand what was happening with my body and mind.”

Traumatic brain injury (TBI), caused by blast exposure from IEDs or improvised explosive devices, is the “signature injury” from the Afghanistan and Iraq wars. Veterans from the war in Iraq experienced an average of two TBIs, according to a 2009 study. 

TBIs, together with chronic pain and PTSD, which is often accompanied by depression or substance abuse, make up what’s known as the “clinical triad.” 

“All of those confer additional risk for suicide,” said Robert Bossarte, PhD, professor of psychiatry at the University of South Florida in Tampa. 

Like many active soldiers, Friedman didn’t share his problems with his chain of command because he was afraid they would take away his weapons and remove him from the duty he had trained so hard to achieve.

Instead, Friedman said he got help “off the books” from God, civilian doctors and nonprofits. 

“God was instrumental in my life,” he said. “I felt like I prayed and he answered. Through this process, I found a purpose and hope.”

Friedman now uses a Belgium Malinois service dog named Zelda to help him deal with symptoms from his brain injury. He said there’s often “an existential moral crisis” when soldiers question why they made it back home and their buddies didn’t. 

“It’s very common for soldiers to come back from war and have a difficult time processing the things they saw with very little help from the [U.S.] Department of Defense,” Friedman said. “They bury these issues and when it rears its ugly head it can be explosive. Chronic stress creates a perfect formula to implode to make the most catastrophic decision during the darkest time of their life.”

Moral wounds

‍Researchers are starting to study what are known as “moral injuries” — actions that conflict with a person’s core values or belonging to a group that takes actions that run counter to core values — and their impact on mental health and suicide risk. 

In a Saint Louis University study, published earlier this year, 20 veterans of the Persian Gulf War and the wars in Afghanistan and Iraq spoke candidly with a retired Army officer about their own pain points. Some veterans noted that the public “respects a man or woman in uniform,” but doesn’t want to know too much about “the ugly side” of battle and “all the reasons why you’ve changed.” People, they said, expect veterans to just “get over it.” 

Other veterans admitted that they’d lost faith with the government that sent them to fight and the politicians who “treated their lives with a very cavalier attitude, and the price they’re paying for it is emotional pain.” They relayed that “their wives and girlfriends have no way to understand or relate to them, they feel alone, and they feel used.”

Blosnich, who was not involved in the study, said in an email to VoxPopuli that he could easily see how this “could raise a person’s distress, contribute to spiraling hopelessness and increase perceptions that a person has fewer options for help/assistance.” 

Indeed, among veterans, first responders and healthcare professionals who screened positive for moral injuries, nearly 66 percent had contemplated killing themselves within the past two weeks, while more than 40 percent had attempted suicide at some point in their lives, according to a study in Nature, published last week. The study authors are calling for moral injury assessments to be added to suicide prevention efforts. 

Military composition

There’s almost an expectation that veterans who’ve seen combat would have a higher risk for suicide. But it turns out that veterans who have never deployed have an elevated risk for suicide as well. In a Syracuse University study of 1.3 million veterans on active duty during the Afghanistan and Iraq wars, the suicide rate among those who never experienced combat was nearly 49 percent higher than among those who did. 

“ It's sort of a mistaken narrative that combat is what is leading to the higher rates of suicide in our nation's veterans,” said Stop Soldier Suicide’s Batten. “It's something that makes logical sense … but it's just not what the research shows.” 

If combat and the traumas experienced in war are not necessarily driving the higher suicide rates among veterans, what is? 

In the last decade, researchers have turned their attention to the composition of the military itself since the draft ended in 1973 and the military transitioned to an all-volunteer model. 

There’s research to suggest that while the draft pulled in a cross-section of the American population, the all-volunteer military draws some people who are already at higher risk for suicide before they enlist. 

A study that Batten co-authored looked at childhood trauma, which is a known risk factor for suicide. A single adverse event in childhood, like physical, emotional or sexual abuse, can double the risk that a person will attempt suicide. 

“[The military] is a place where you can get a stable job, you can get a career, you can get skills training, you can get the GI bill and get education benefits. You can get healthcare, you can get a sense of purpose and meaning, all of those things,” she said. “For somebody who maybe grows up in a situation where that sort of path is not as clear from their own family and neighborhood, [the military] ends up being one of those entry ways into opportunity. But there just may be more representation of individuals who have had difficult events in their childhood.”

In Batten’s study, researchers looked at the prevalence of “difficult events” among active duty service members, veterans who had volunteered, veterans who had served during the draft and people with no military service. The researchers found a higher prevalence of difficult events in childhood among those who volunteered for the military compared to those who joined during the draft era — and an even higher prevalence compared to those with no military service.

Among the military men in Batten’s study, sexual abuse — including rape before age 18 — was twice as likely among those who volunteered for the military compared to those who never served. Rape in childhood raises a man’s risk for a serious suicide attempt by 11 times. 

The Army’s STARRS-LS study, the most extensive study of mental health among Army service members, underscored the evidence that volunteers came into the military with elevated risk factors for suicide. In the study, more than 76 percent of participants had mental health issues before they joined the military, and nearly half had attempted suicide at least once before enlisting. (Attempted suicide is screened for and is typically a disqualifier for military service.) Soldiers were also found to have higher rates compared to civilians of explosive anger disorders, substance abuse and attention-deficit/hyperactivity disorder. 

Harvard Medical School’s Ronald C. Kessler, PhD, one of the study co-authors, told PBS in 2014, “One thing that has caught all of us by surprise … is how many people came in before they had any exposure to traumatic military experiences with problems that subsequently were deemed to be important.”

What’s being done? 

Veterans who receive healthcare through the VA are screened for suicidal ideation at every medical visit. Local veterans have access to same-day emergency mental health care at the Orlando VA Healthcare System. Established patients can schedule healthcare appointments within 18 days, according to Joseph Nunez, public affairs specialist at the VA. Eligible veterans who don’t live near a VA facility have the option of receiving care in their community or via telehealth.

The VA offers primary care, mental health, specialty outpatient care for PTSD and residential and acute inpatient mental health treatment. As a way of reducing the stigma of mental health treatment, the VA integrates mental health providers into primary care so problems can be picked up during routine health care visits, Nunez said. 

However, the VA plans to slash 80,000 jobs under a restructuring proposal to meet President Donald Trump’s executive order for downsizing the federal government. It also mandated that 60,000 VA employees, including mental health professionals who were working remotely, return to federal offices, which often are not designed for private consultations and are located far from rural communities. 

The 2,400 probationary employees fired from the VA in February were allowed to return to work following a court order in March that rescinded their terminations. A VA spokesman said the department has not yet implemented its reduction-in-force plans. 

“VA’s goal is to bring back as many employees to the office as space permits so we can work together as a team to deliver veterans the best care and services possible,” said Nunez.

“Preventing suicide is a top priority for the VA,” he said.

Even so, Winter Park therapist Priscilla Hill said she has talked to vets who have waited for months to get a VA appointment. Her father, also a veteran, went to the VA three times and left before finally seeing someone after a four-hour wait.

“Unfortunately, they have to jump through a lot of hoops to get an appointment,” said the CEO of F.R.E.S.H. Behavioral Services in Winter Park, which specializes in treating veterans. “They don’t have the time to go through the bureaucracy and some give up. The VA can only handle so much. Thank God they are contracting with private providers.”

Hill’s Winter Park clinic is one of several providers that the VA contracts with to work with veterans. She said her clinic responds to vet calls within 24 hours. It also offers group therapy for veterans led by a therapist who is also a veteran because the clinic recognizes that veterans struggle to reach out for help. 

“Military training teaches soldiers to be strong and resilient and many think they can solve their own problems,” Hill said. “Some vets feel that only someone who has been through combat or served in the military can understand what they are going through. That’s why we offer support groups just for veterans.”

With so many resources dedicated to curbing suicide rates among veterans, can that move the needle? 

At a recent city commission meeting in Winter Garden, Gies claimed that none of the more than 10,000 veterans who, he said, have been assisted through Challenge 22 have died by suicide. 

USC’s Blosnich said while he is a pragmatist, he sees some difference. 

 ”Suicide is unlike any other leading cause of death in the country,” he explained. “This cause of death is the person saying, I want to die. I don't want to live anymore.  We don't fully understand how someone gets to a point where they override an innate will to survive.”

He points to public health advocate Howard Koh, a former senior public health official in the Obama administration, who famously said: “When prevention works, absolutely nothing happens. All you have is the miracle of a perfectly healthy, normal day.”

“One of the hardest things about public health is when you prevent something you don’t know that it didn’t happen, right? You only count when things do happen,” Blosnich said. “It's very hard to have a ticker tape parade over nothing. And it's very hard to get policy makers to fund things when you're gonna promise nothing will happen.”

So Blosnich looks at what might have been and sees improvement in what he believes didn’t happen because things like large community-based VA outpatient clinics exist and there are suicide prevention coordinators at every VA medical center and the department has instituted a dedicated 24/7 crisis line. 

Veteran suicide rates, he said philosophically, “could have been incredibly worse than what they are now.”

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If you or a veteran you know is struggling, dial 988 then press 1 to connect to the VA’s Veterans Crisis Line. You can also chat online or send a text message to 838255 to receive confidential support 24 hours a day, seven days a week, 365 days a year.