Following worldwide concerns surrounding the COVID-19 pandemic and its impact on mental health, Ian Stanley, PhD, assistant research professor of emergency medicine in the CU School of Medicine and psychological health lead for the Center for Combat Medicine and Battlefield (COMBAT) Research, began investigating whether the pandemic impacted military veterans differently than non-veterans.
According to the U.S. Department of Veterans Affairs, over the past two decades, the age- and sex-adjusted suicide rate for veterans is higher compared with non-veterans. Stanley, who specializes in studying military communities and post-traumatic stress disorder, was particularly interested in how the COVID-19 pandemic affected suicidal ideation, plans, and attempts for veterans versus non-veterans.
In his study, Stanley analyzed data from the 2021 National Survey on Drug Use and Health (NSDUH). He found that while veterans were significantly more likely than non- veterans to report past-year suicidal ideation, plans and suicide attempts, veterans were significantly less likely than non-veterans to attribute their suicide-related experiences to the COVID-19 pandemic. He and his coauthors attribute these findings to the “warrior mindset” that comes with military experience.
Stanley’s study was published today in the Journal of the American Medical Association (JAMA) Network Open.
Resiliency in results
In early 2020, Stanley coauthored an opinion article, “Suicide Mortality and Coronavirus Disease 2019—A Perfect Storm?,” which prompted him to initiate the study on veterans’ suicide-related experiences attributed to the pandemic.
He used NSDUH data to analyze responses from 47,291 adults 18 and older to questions about suicidal ideation, planning, and attempts. Some of the questions asked responders to report whether mental health concerns or suicide-related experiences occurred due to the COVID-19 pandemic.
Results showed that veterans were significantly less likely than non-veterans to attribute their suicidal ideation, suicide plans, and suicide attempts to the COVID-19 pandemic. They were also significantly less likely than non-veterans to attribute adverse mental health, broadly, to the COVID-19 pandemic.
“From these findings, we may infer that many veterans are resilient to the psychosocial effects of tragedies, such as COVID-19, due to their military experiences, but it should not be lost that veterans still experience elevated rates of suicidal thoughts and behaviors compared with nonveterans,” says Stanley. “These findings underscore the need for a multilayered suicide prevention approach for this population.”
Shifting the warrior mindset
“In so many cases, veterans don't reach out and share their mental health struggles. We describe it as a 'warrior mindset,’ which means doing whatever it takes to get through something traumatic,” Flarity says. “In one day alone, our service members see what most of humanity does not see in a lifetime.”
Stanley collaborated with two military experts on the study. Both experts have led trainings on resiliency and launched wellness initiatives for medical and military professionals.
Working with Kathleen Flarity, DNP, PhD, Brigadier General (ret) United States Air Force, deputy director for the Center for COMBAT Research, and LTC Michael D. April, MD, PhD, who is an active duty military emergency physician and commander and has collaborated with the Center for COMBAT Research, they hope to shift the “warrior mindset.”
Flarity leads a resiliency training called “Passion in Practice,” which has seen an uptick in enrollment since the COVID-19 pandemic, leading her to believe that military populations and other professions with high rates of compassion fatigue and burnout are still feeling the effects of the pandemic.
“In so many cases, veterans don't reach out and share their mental health struggles. We describe it as a 'warrior mindset,’ which means doing whatever it takes to get through something traumatic,” Flarity says. “In one day alone, our service members see what most of humanity does not see in a lifetime.”
In her resiliency trainings, Flarity encourages participants to share their own experiences as a form of connection and healing. “Resiliency and seeking help go hand-in-hand; they’re signs of courage and strength,” she emphasizes. “We are hoping the culture continues to transform in this next generation of service members.”
Both Flarity and Stanley hope to see an increase in veterans seeking help for mental health challenges, including suicidal thoughts.
Stanley says the study finding’s point to a critical question: “How do we harness the ‘warrior mindset’ to promote help-seeking as one avenue to decrease suicide risk?”
“We need to ask the right questions in this type of work. Psychological health is the third pillar of the mission for the Center for COMBAT Research,” Flarity says. “Since we’ve welcomed Ian to the team, we’ve seen a new level of research innovation at COMBAT. It’s work that changes science, but taking care of individual people is what we really care about.”
