Veteran suicide rates are declining, but remain high for those with brain injuries, research shows

After climbing for nearly two decades, suicide rates among U.S. military veterans have shown a significant decline since 2020, according to new research from the University of Utah.

The study, published in JAMA Network Open, provides hopeful data following a grim period where veteran suicide rates—particularly among those with a traumatic brain injury (TBI)—far outpaced the general population.

"When we started looking at this earlier, there was actually a protective effect for being a veteran. It was called the 'Healthy Warrior Effect,'" said principal investigator Mary Jo Pugh, a professor of epidemiology at the University of Utah’s Spencer Fox Eccles School of Medicine.

This protective effect, however, reversed as the War on Terror continued.

"Our earlier work showed that around 2006 is when veteran rates of suicide... started to increase," Pugh noted. "That's after a period of people being deployed to wars repeatedly since 2001 or 2002. But it’s not just deployment because those who deployed had lower rates of suicide—it is a complex issue."

The disparity quantified by Pugh's study is stark: While U.S. adult suicide rates reached about 20 deaths per 100,000 people by 2020, the rate for post-9/11 veterans with TBI peaked at 100 deaths per 100,000, and 61 per 100,000 for those without TBI. According to the Veterans Administration, more than 140,000 veterans have died by suicide since 2001.

The study's most important finding is that veteran suicide rates have dropped sharply since 2020. Pugh suggests this may be due to a "critical mass" of suicide prevention measures, such as the Prevention 2.0 Initiative, the Suicide Prevention Now initiative and the President’s Roadmap to Empower Veterans.

"There's been a huge emphasis on safe gun use, like providing veterans locks for their guns, which may have an impact," Pugh said, noting that most veteran suicides involve firearms.

However, she believes it's a combination of factors. "They've got a variety of different approaches to help people... reduce impulsive behavior," she added. "One size never fits all for any kind of mental health condition or treatment."

Pugh, a former nurse in the Air Force, brings a personal perspective to the research. She was medically retired after suffering polytrauma injuries (including TBI) in a bicycle collision with a car piloted by a drunk driver. She went on to earn a PhD in developmental psychology, which she has used to examine long-term outcomes of military experiences such as TBI.

Eight years ago, she brought her research group, TORCH (Trajectories of Resilience, Community and Health), to the University of Utah. Pugh’s team developed a cohort of all service members and veterans who served on active duty after 9/11 for three or more years (>2.5 million) to conduct population-based analyses of outcomes associated with TBI and other exposures.

The group's recent work on TBI has earned Pugh the Outstanding Research Accomplishment award at the 2025 Military Health System Research Symposium for its groundbreaking research on the long-term outcomes of TBI. That research demonstrates that the consequences of TBI—which affects about one in five post-9/11 veterans—go far beyond suicide risk. Her team found TBI is also linked to other long-term health consequences, including dementia, substance use disorder, and even cardiovascular disease.

"Documenting these patterns of risk is a crucial step toward implementing preemptive interventions to help veterans stay healthy," Pugh said.

TORCH and its affiliated scientists have published numerous studies linking various health outcomes and TBI in veterans, with more studies in the pipeline. Another recent study documents elevated risk for cancers of the central nervous system (CNS), such as glioblastoma, for female veterans with TBI.

This paper examined data covering 422,715 female veterans with 1,229 cancer deaths from 2002 to 2020. “The mortality rate ratio was much higher, almost six times higher than the general population,” she said. The finding is in line with other studies that found elevated CNS cancer risk for those with brain injuries even among civilians. What might increase the risk for service members and veterans is the inflammation associated with TBI and environmental exposures, including burn pits, occurring alongside the head injury.

“If you have a more severe injury where there's a blood-brain barrier breach—and even now we find that even with mild TBI, sometimes there's a blood-brain barrier breach— and if your injury occurs in a situation where there might be fire or flames, even a car accident, that might get into the brain and increase the likelihood of having an exposure that's synergistic with the TBI,” Pugh explained.

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Both these studies appear in JAMA Network Open. The one titled, “Suicide Rate Trends for Post–September 11, 2001, US Military Veterans,” was published Sept. 3, listing Jeffrey Howard of the University of Texas, San Antonio at first author. The second study, titled “Cancer Mortality Rates in Female Veterans With and Without TBI,” was published March 13, listing Christin DeStefano of the Walter Reed National Military Medical Center as first author. Funding was provided by the Department of Defense and the Department of Veterans Affairs.