Suicidal Thoughts, Behaviors, and Mental Health Treatment Use in US Military Veterans

Shifts in the demographic composition of US military veterans underscore the need for updated population-based estimates of suicidal thoughts and behaviors (STBs) to accurately characterize suicide risk in this population.

To update prevalence estimates of and factors associated with STBs among US military veterans and to examine mental health treatment utilization among veterans with a history of STBs, stratified by use of the Veterans Health Administration as a primary source of health care.

Population-based cross-sectional study of US military veterans drawn from the 2025 to 2026 National Health and Resilience in Veterans Study.

Past 2-week and past-year suicidal ideation (SI), lifetime planning, and lifetime suicide attempt(s).

Among 2636 veterans (mean [SD] age, 62.4 [16.2] years; 2349 [88.5%] male), the prevalence of past 2-week SI was 13.4% and past-year SI was 14.0%, with past 2-week SI significantly higher in 2025 to 2026 than in 2019 to 2020 (13.4% vs 9.0%; z = 5.69; P < .001). In contrast, prevalence estimates of lifetime suicide planning (8.0% vs 7.3%; z = 1.06; P = .29) and suicide attempts (4.9% vs 3.9%; z = 1.97; P = .048) were similar to those observed in 2019 to 2020. After adjustment for sociodemographic and military characteristics, factors most strongly associated with past 2-week SI based on relative importance analyses included functional disability (odds ratio [OR], 1.10; 95% CI, 1.04-1.16), lifetime major depressive disorder (OR, 2.22; 95% CI, 1.63-3.02), and lifetime posttraumatic stress disorder (OR, 1.53; 95% CI, 1.09-2.13). Factors most strongly associated with past-year SI included functional disability (OR, 1.09; 95% CI, 1.07-1.11), lifetime major depressive disorder (OR, 2.33; 95% CI, 1.72-3.16), and lifetime posttraumatic stress disorder (OR, 1.62; 95% CI, 1.17-2.25). Factors most strongly associated with lifetime suicide planning included lifetime posttraumatic stress disorder (OR, 2.61; 95% CI, 1.82-3.76), lifetime major depressive disorder (OR, 2.61; 95% CI, 1.84-3.71), and younger age (OR, 2.11; 95% CI, 1.36-3.28). Factors most strongly associated with lifetime suicide attempts included greater adverse childhood experiences (OR, 1.39; 95% CI, 1.29-1.51), lifetime major depressive disorder (OR, 3.76; 95% CI, 2.31-6.10), and functional disability (OR, 1.04; 95% CI, 1.02-1.07).

In this cross-sectional study of US military veterans, results suggest that SI was more prevalent in 2025 to 2026 relative to estimates from 2019 to 2020, whereas the prevalence of suicide planning and attempts remained stable. Younger and female veterans appear to carry disproportionate risk for STBs. Targeting key risk factors in vulnerable subpopulations may help mitigate suicide risk.