Combating Veterans “Deaths of Despair”

Tim Strauman
Working on strategies to minimize the risk of suicide among Veterans was a project of great personal significance for Timothy Strauman, professor of Psychology & Neuroscience, whose father served in WWII. (John West/Trinity Communications)

In 2020, the suicide rate for Veterans was 57.3% greater than for non-Veteran U.S. adults, adjusting for age and sex differences.

This statistic underscores the vital importance of  Timothy Strauman’s research. The Professor of Psychology & Neuroscience studies the factors that influence our ability to regulate our emotions and the health consequences, including depression and suicide, that can arise when we’re unsuccessful.

One of his most recent projects focused on a population that is particularly vulnerable to depression and its sometimes-fatal consequences: returning Veterans.

In the Spring 2023, Strauman helped plan and chaired two National Academies meetings focused on reducing suicide risk among Veterans. The meetings and the discussions generated by them were summarized in Identifying and Managing Veteran Suicide Risk: Proceedings of a Workshop. We chatted with Strauman to learn about the motivation behind these meetings and the recommendations derived from them.

This interview has been edited for clarity and length.

Can you tell us a bit about these meetings and how you became involved in them?

I was part of a standing board from the National Academies of Science, Engineering and Medicine called the Board on Behavioral, Cognitive and Sensory Sciences. This board is tasked with being honest brokers of science, bringing an unbiased science-based judgment or recommendation to topics that can be very politically fraught.

A couple of colleagues and I were discussing “deaths of despair,” where people who are struggling with their place in society seem to have a particularly high rate of suicide. One of my colleagues was looking specifically at Veterans returning from deployment, and the VA were fabulous sponsors right away. The VA is a world leader in developing and testing the best behavioral interventions in traditional mental health crises. We narrowed the focus of the meetings to “How can we bring the best behavioral and social science to bear on helping the VA with its critical mission of suicide prevention?”

My job was to organize and run the meetings. At the first meeting, we had participation from cultural anthropologists, linguists, cognitive scientists, neuroscientists — it was the smartest collection of people I've ever seen in my life. The primary audience was VA workers outside of hospitals. We heard from people who said “We do suicide prevention by delivering firewood to homeless people. We make sure that people who don't have cars get rides to their local medical clinics.” It was just astounding.  

We held a follow-up meeting focusing on the disparity between the mental health care provided at the VA vs. outside of the VA system. Veterans often seek mental health care at facilities that can’t match the level of care the VA provides. The challenge is how to make it easier for Veterans and their families to get the best care they can get in the community they live in.

Why did you focus on Veterans when researching “deaths of despair?”

The military is a microcosm of much of American society. The armed forces are about 35% women and about 50% non-white. On average, these are people with fewer economic resources to whom military service can be highly attractive and beneficial. It's an all-volunteer corps now, and what we expect them to do is extraordinarily difficult. I personally have never served in the military, there's nothing in my life that will ever approximate that, and I will never pretend that it does. I am honored just to say that my father served during WWII, but he rarely spoke about it. It's a set of life experiences that only the people who lived it really understand. Thankfully, a lot of the people on the ground with the VA and local communities have served or had family members who served. They get it.

People would say “We had to learn to pull a trigger without guilt. And then when we came home, we were expected to unlearn it.” Think about that, right? It's heart-wrenching and it's so admirable. That's why it means so much to me to help Veterans stay healthy when they return from deployment. What we ask them to do is extraordinary, and we need to be doing more for them. 

What were some of the key recommendations drawn from the meetings? 

The major recommendation of the first meeting was to organize the remarkable work taking place on the ground so that there are regional and national resources to help people.

The recommendation from the second meeting focused on non-VA healthcare systems. If they are going to be charged with the responsibility of providing mental health care for VA eligible people, then there needs to be a more systematic way of ensuring quality control. If you're in the VA system, the whole system is tailored for you. Take women who are returning veterans, for example, and who want to start a family. They’ll have different kinds of perinatal healthcare needs, which VA medical providers know, but hardly anybody outside of the VA does. So, the intent was “How can we make sure that these Veterans are getting the best care, offered by people who understand what it means to be working with a Veteran?”

How does this project relate to your research at Duke?

The Board was looking for someone trained as a basic experimental social psychologist who was also a clinical psychologist. My research is primarily on depression and the ways people think about themselves that could predispose them to becoming depressed over time, so I was really drawn to the concept of “deaths of despair.” If you see yourself as having no power, as being part of a group that is at the bottom of the pecking order, if you feel lonely, all the things that predispose people to depression, to substance use, to gun violence — which is synonymous with suicide — all of them happen with deaths of despair.

This work makes me broaden and rethink what it means to be on a trajectory that leads you to depression and how early we can provide interventions. My closest research collaborator, Dr. Ann Brewster, and I are doing intervention and prevention work for high-risk adolescents using a model that would be a wonderful match to the VA. It has given me the opportunity to interact with people who are at risk at an even earlier point than when they would be volunteering for military service. It's so rewarding to be able to make a difference. It sounds like a cliche, but it's not. It really is incredibly satisfying. 

Is there anything we can all do to help reduce the risk of suicide in Veterans? 

This is subtle but remarkably powerful: just convey respect. Respect, recognition of how hard it is to serve and how hard it is to return from deployment, and show gratitude.

The other thing we can do is keep our politicians accountable for continuing to provide all the support that Veterans need and deserve. If that's something that people can take away from Veteran's Day, that would be a terrific outcome.