Universal suicide risk assessment for veterans and soldiers in all healthcare settings: A nursing imperative

Suicide remains a major public health concern among U.S. veterans and active-duty military personnel. This narrative review examines evidence supporting routine suicide risk screening and considers its implementation as a clinically appropriate, trauma-informed process rather than an inflexible requirement at every encounter.

A structured narrative review used targeted searches of PubMed, CINAHL, PsycINFO, and Scopus, supplemented by federal surveillance reports, clinical guidance, and policy documents. Evidence was synthesized across five domains: suicide prevalence and trends; clinical, cultural, and system-level risk factors; recognition gaps in general healthcare; routine screening and early intervention; and nursing leadership in implementation.

Veterans and active-duty personnel experience multifactorial suicide risk associated with post-traumatic stress disorder, depression, moral injury, substance use, chronic pain, traumatic brain injury, transition-related stressors, stigma, and access to lethal means. Missed opportunities for recognition also occur in nonpsychiatric settings. Validated screening can facilitate early identification but requires pathways for secondary assessment, safety planning, referral, and emergency response.

Routine suicide risk screening should be integrated into healthcare encounters when screening can be completed safely, privately, and with an established response pathway. Nurses are well positioned to lead standardized workflows, culturally responsive communication, staff education, and quality improvement. Broader implementation requires organizational policy, workforce preparation, and further evaluation across military and civilian healthcare systems.