The largest study yet on suicide risk among veterans suggests that younger returning soldiers may be at greatest risk of taking their own lives and that more resources may be needed to curtail suicide in this age group.
The study focused on 807,694 depressed veterans in the VA health care system from 1999 to 2004.
Authors note that the findings are not unique to the Middle East conflict, implying they could be applied to other wartime situations as well.
"Most were not involved in the current war," said co-author Dr. Marcia Valenstein, research scientist in the Department of Veterans Affairs Health Services Research and Development Service, of the veterans studied.
For some researchers, the findings are not surprising. Dr. Paul Ragan, associate professor of psychiatry at Vanderbilt University Medical Center in Nashville, Tenn., said the scientific community has been aware for some time now that younger veterans are heavily affected by suicide.
He added that suicide rates in the general population tend to peak in two age groups -- one at ages 15-24 and another at ages 40 and up. Such a pattern, he suggests, may also be consistent with that of the military population.
Moreover, he said, "suicide rates among ages 15-24 have been steadily increasing over the last 20 years in the U.S.
"This is not a new finding."
But Ragan said what disturbs him most is the sheer magnitude of suicide among U.S. veterans compared with the general population, and he is concerned that it will only escalate as young vets return home from the Middle East.
Dr. Harold Koenig, professor of psychiatry and behavioral sciences at Duke University School of Medicine in Durham, agrees with this theory.
"I think it's been everybody's impression that suicide rates in veterans, especially those coming home from the Middle East, were much, much higher than for people in the general population," he said.
Some psychological experts say that younger soldiers are at greater risk of suicide because they lack the life experience of older veterans, which may serve as a protection of sorts from succumbing to suicide.
"One could hypothesize that older veterans have a higher resilience level as compared to older nonveterans," said Dr. Israel Liberzon, chief of psychiatry service at AAVAHS in Ypsilanti, Mich. "The fact that the 'older' veterans remain in active military potentially pre-selects to higher-functioning individuals."
Koenig agrees with this assessment. "Younger veterans... have probably experienced less trauma and tragedy," he said. "That is all new for them, and first experiences of anything are more traumatic than if you've experienced it many times before."
Another factor cited by Koenig suggests that older veterans are particularly "hardy" survivors. "[Those with] suicidal tendencies may have already committed suicide," he said.
More surprising, the lead authors note, may be the finding that depressed patients who also had post-traumatic stress disorder, or PTSD, appeared to have a lower suicide risk than those with clinical depression alone.