County Characteristics and Veteran Suicide in the United States, 2011–2018

Few studies have examined county-level hotspots of veteran suicide and associated place-based contributors, limiting development of targeted community-level prevention strategies. The objectives of this national spatial analysis of all veteran suicides were to identify areas of the United States with higher-than-expected veteran suicide rates and determine county-level social and economic characteristics associated with areas of higher risk. Using Bayesian hierarchical modeling, county-level standardized mortality ratios for veteran suicide deaths were estimated for time periods 2011–2018, 2011–2014, and 2015–2018. Adjusted relative risk, accounting for community characteristics, for each county was then estimated and associations between community characteristics and veteran suicide risk were examined. Analyses were conducted in 2023–2024. Risk of veteran suicide is predominantly concentrated in the Mountain West and West. Significant predictors of risk across all time periods were per capita number of firearm retailers (2011–2018 relative risk [RR]=1.065 [95% credible interval [CI] 1.030–1.102]), the proportion of residents who moved in the past year (2011–2018 RR=1.060 [95% CI 1.039–1.081]), the proportion of residents who live alone (2011–2018 RR=1.067 [95% CI 1.046–1.089]), the proportion of residents in rental housing (2011–2018 RR=1.041 [95% CI 1.018–1.065]), and the proportion of married residents (2011–2018 RR=0.915 [95% CI 0.890–0.941]). This study contributes to a comprehensive public health approach to veteran suicide prevention by identifying where resources are needed most, and which place-based intervention targets have the largest potential for impact. Findings suggest that public health efforts to address suicide among veterans should address community-level firearm access and identify ways to alleviate deleterious effects of social fragmentation.