Better With Them

Better With Them

Death by suicide has become a public health issue, particularly for military veterans.

Researchers part of nationwide study to identify veterans struggling with suicidal thoughts

By David Miller

When someone dies by suicide, members of their community ask “why?”

Why did they take their own life? Why didn’t they get help? Why didn’t anyone know?

Some correlations and risk factors for suicide are well established – depression, trauma, violent behaviors and drug abuse – but suicides in the United States continue to increase. They are now the 10th-leading cause of death in the country, according to the Centers for Disease Control.

Death by suicide has become a public health issue, particularly for military veterans, who are twice as likely as civilians to die by suicide, according to a recent study by the Department of Veterans Affairs.

“When you come from the military – a small, structured unit you’re exceptionally close and tied to – then go back into general society, it can be problematic,” said Dr. Karl Hamner, a researcher at The University of Alabama.

A professor studying veteran suicides stands amidst the U.S. and military flags.
Dr. Karl Hamner

The answers to stemming veteran deaths by suicide may rest in the communities themselves. Researchers at UA, working with America’s Warrior Partnership, AWP, are digging beyond clinical factors to help communities identify members who are declining to potentially prevent suicides.

UA will soon complete the first year of “Operation Deep Dive,” a four-year, $2.9 million study to explore and better understand organizational and community risk factors that contribute to suicide and intentional self-harm among military veterans. AWP, a non-profit organization helping veterans succeed in communities, connected UA researchers with members of its seven affiliate communities across the country, creating vital networks for data collection.

Hamner and Cheree Tham from AWP lead the study that aims to collect information and begin communitybased suicide prevention. While clinical interventions and treatment are important, they’re not sufficient to prevention work, Hamner said.

“Death by suicide is never an isolated act,” Hamner said. “It may seem so, but it’s always in the context of the community in which they’re living, which is impacting that decision. “You can’t do public health prevention work if the public isn’t involved.”

Community Relations

The study is ambitious. With guidance from Dr. Eric Caine, a leading suicide research and prevention expert from the University of Rochester, the research team focuses on veterans across a spectrum of service.

It begins with a retrospective investigation into the impact of discharge status on suicides and suspected suicides, use of VA care, and the differences in suicide/self-harm deaths between those who received VA care and those who did not.

The findings will be incorporated into a four-year study that will include data from the VA and the federal Department of Defense, both partners in the study, along with input from medical examiners, mental health experts, veterans and family members, and the community. This will be used to conduct a “sociocultural autopsy” of all new or suspected suicides in AWP’s seven partnership communities, as well as in comparison communities.

Working the community connections has been demanding and “complex,” from a methodological perspective, Hamner said. Researchers face challenges in collecting data, particularly with organizations agreeing to provide data while fulfilling confidentiality requirements. The process of obtaining death reports or vital statistics from each state is complex, too, and the type of available data often varies by county.

A hand clutches military dog tags against a black background.
PTSD nor combat exposure are good predictors of veterans and suicide, so researchers must cast a wider net to find reliable predictors.

It’s equally as difficult to accurately identify veterans who die by suicide, and Hamner believes coroners and medical examiners, first responders and emergency rooms could fill future gaps in data by establishing uniformed protocols for confirming someone’s military service.

Medical examiners, coroners and church clergy participate in AWP’s Community Action Teams in cities like Buffalo, New York and Pensacola, Florida, where they meet monthly to discuss topics relevant to suicide prevention and veterans. The study’s partnerships have also grown to include corporations like Radiant Solutions, which will assist with geo-mapping of reported suicides, and an emerging partnership with the Center for Disease Control’s Injury Prevention & Control Center.

“There’s no single repository for information in any community about someone who has died by suicide, or a death report on anyone,” Hamner said. “But while the barriers are frustrating, the willingness of people to work on this has been far greater than I thought it would be.”


Recent research has shown that neither post-traumatic stress disorder, or PTSD, nor combat exposure are good predictors of veterans and suicide, so researchers must cast a wider net, even if it lands in unusual places, Hamner said.

Hamner pointed to Washington County, Oregon, where suicide investigation teams comprised of public health officials and coroners are examining social connections and indicators. They identified a subset of cases where people who died by suicide checked their pets into vets or animal shelters, though the pets were perfectly healthy.

“This isn’t something that would be a total surprise – people take care of their pets – but what the county did was, they saw this pattern, and they went around to all of their shelters and vets and trained them to watch for this,” Hamner said. “Early this year, they had several calls related to this and were able to intervene and prevent a suicide.”

This innovative approach can ultimately help researchers determine the dynamics of a community and how it helps or hurts veterans, who often feel isolated once leaving the military, even in a city such as Pensacola, which has a large military community but high rates of veterans who’ve died by suicide.

“We’re hoping to be able to ID more community pieces that are actionable,” Hamner said. “How do we find someone who is struggling with housing, paying their bills, or any number of factors where we might be able to help them and avoid the conclusion that ‘the world is better off without them.’”

Dr. Hamner is a clinical associate professor of educational research and director of the Office of Evaluation for the College of Education. The Bristol-Myers Squibb Foundation supports this project.