Most veterans and U.S. military service members who die by firearm suicide don't disclose their suicidal intentions in the month before their death, according to Rutgers researchers.
Their study , published in The Journal of Crisis Intervention and Suicide Prevention, examined the patterns of 28,600 individuals with a history of military service who died by firearm suicide between 2013 and 2021. Using data from the National Violent Death Reporting System , researchers sought to understand how often service members and veterans communicated suicidal thoughts before their deaths and, when they did, who they chose to tell.
"Most veterans and service members who die by firearm suicide do not disclose their suicidal thoughts before their death, so we can't rely on prevention efforts that only begin when someone tells us they're suicidal," said Allison Bond , assistant professor with the New Jersey Gun Violence Research Center at the Rutgers School of Public Health and lead author of the study. "Upstream, universal prevention strategies are needed to reach the many individuals who may never disclose their risk to anyone."
Veterans face an elevated risk of suicide with firearm suicide accounting for nearly three-quarters of veteran suicide deaths. The research shows that many veterans who die by suicide never engage with professional mental health services before their deaths. Recognizing warning signs is a key first step in intervention opportunities, the researchers said.
They found that 21.2% of service members and veterans who died by firearm suicide disclosed suicidal thoughts or plans within the month before their death. Nearly 4 out of 5 individuals didn't communicate their suicidal intent before their deaths.
Among those who disclosed suicidal thoughts or plans to act on them, intimate partners were the most common recipients of those disclosures, with 41.8% confiding in a spouse or partner. Family members were the second most common source at 30.5%, followed by friends or colleagues at 12%. In contrast, 4.7% disclosed suicidal thoughts to a health care provider. No matter the demographic group, individuals who revealed suicidal thoughts were most likely to confide in their intimate partners and family members.
"When someone does disclose their thoughts of suicide, they are most often telling their loved ones rather than health care providers," Bond said. "This really highlights the importance of equipping military families with the tools and resources to recognize risk and respond effectively. We need to support families so they know how to respond when someone is struggling. That's how we're going to save more lives."
The research suggests that suicide prevention efforts focused exclusively on clinical settings might miss many individuals at risk. Because disclosures most often occur outside professional environments, around family members, intimate partners, friends and community organizations, these settings play a critical role in identifying risks and supporting prevention efforts.
The study highlights the potential value of community-based suicide prevention strategies that don't rely on individuals actively seeking help or disclosing suicidal thoughts. However, approaches that include public awareness campaigns, firearm safety education, training in secure firearm storage and the distribution of firearm locking devices help trusted community members recognize and respond to warning signs, researchers said.
"These efforts may be particularly effective when implemented through veteran-serving organizations, military communities, and the Department of Veterans Affairs facilities," Bond said. "There needs to be a reduction of stigma surrounding mental health and help-seeking within military and veteran communities, so having programs like this will encourage those who suffer from suicidal thoughts."
