Differentiating suicidal thoughts, plans, and attempts in U.S. military veterans

Although numerous risk and protective factors have been identified as correlates of suicidal thoughts and behaviors (STBs), less is known about factors that differentiate increasing levels of suicide risk, from suicidal ideation (SI) to suicide planning (SP) to suicide attempts (SA). This study examined the prevalence and correlates of these STB stages in a nationally representative sample of U.S. veterans.

Data were analyzed from the 2025-2026 National Health and Resilience in Veterans Study (NHRVS; N = 2636). Weighted estimates were used to determine the lifetime prevalence of SI, SP, and SA. Multivariable binary logistic regression analyses examined sociodemographic, military, psychiatric, and clinical characteristics associated with (1) SI vs. no lifetime history of STBs, (2) SP vs. SI, (3) SA vs. SI, and (4) SA vs. SP.

The prevalences of SI, SP, and SA were 18.9%, 8.1%, and 5.0%, respectively. In multivariable analyses, SI (vs. no STB history) was associated with younger age, greater adverse childhood experiences (ACEs) and cumulative trauma burden, higher self-criticism, lower meaning in life, lifetime non-suicidal self-injury (NSSI), and major depressive disorder (MDD). Relative to SI, SP was associated with age, identifying as Non-Hispanic Black, being widowed, divorced, or separated, NSSI, and MDD, and posttraumatic stress disorder. Relative to SI, SA was associated with greater ACEs, NSSI, and anxiety disorder, while SA (vs. SP) was associated with greater ACEs, anxiety disorder, being unpartnered, and identifying as biracial/multiracial.

Findings broadly support ideation-to-action theories and suggest suicidal thoughts and suicidal behavior in U.S. veterans may be influenced by overlapping but distinct processes. They also underscore the importance of addressing both distal vulnerability processes and proximal behavioral risk factors across stages of STBs to inform more precise and stage-specific suicide prevention strategies.