Mental Health

New research challenges the assumption that long-term cannabis use improves symptoms or functioning in posttraumatic stress disorder (PTSD).

On the contrary, researchers found that abstaining from cannabis for 3 months was associated with significantly greater reductions in PTSD symptoms in adults with PTSD and comorbid cannabis use disorder (CUD).

The data suggest that continued cannabis use could limit recovery in some domains — underscoring the need to routinely assess cannabis use during PTSD treatment and to educate patients on the potential consequences of continued use, the researchers said. 

The study was published online February 18 in the Journal of Clinical Psychiatry. 

Helpful or Harmful? 

PTSD is a debilitating psychiatric condition marked by intrusive memories, avoidance, negative changes in mood and cognition, and hyperarousal. Many patients turn to cannabis to ease symptoms. In one recent study, roughly 28% of individuals with PTSD reported past-year cannabis use and 9% met criteria for CUD. 

Although some studies have suggested PTSD symptom reduction with cannabis or cannabinoid-based treatments, others have identified potential risks, such as disrupted fear-extinction learning and worse clinical and treatment outcomes. 

A recent systematic review found mixed evidence overall, with six studies suggesting benefits, five reporting worsening of symptoms, and three showing no significant impact of cannabis use in the setting of PTSD.

Led by Ahmed Hassan, MD, University of Toronto, Ontario, the researchers recruited adults aged 18-65 years with confirmed PTSD and CUD through the Centre for Addiction and Mental Health in Toronto and asked them to discontinue cannabis for 12 weeks.

Abstinence was defined as a urine 11-nor-9-carboxy-tetrahydrocannabinol level of 50 ng/mL or lower with no self-reported use, verified at multiple timepoints. Participants received escalating cash incentives for remaining abstinent at weeks 4, 8, and 12.

Eleven (52%) of the 21 participants who completed the 12-week protocol achieved biochemically verified abstinence, while 10 did not.

Those who achieved abstinence reported significantly greater reductions in total PTSD symptom severity and symptom count compared to those who did not. 

Total severity scores on the Clinician-Administered PTSD Scale for DSM-5 dropped from 36.2 at baseline to 10.5 at week 12 among abstainers vs 34.6 to 21.8 among those who did not maintain abstinence (P = .001).

A similar pattern emerged for total symptom count, with abstinent participants dropping from 14.3 symptoms at baseline to 4.1 at week 12, compared to a decrease from 13.5 to 8.9 among nonabstainers.

Notably, the investigators observed that individuals who remained abstinent showed greater reductions in several core symptom clusters, including avoidance, negative alterations in mood, cognition, and hyperarousal — domains that are often cited as targets for cannabis-based self-medication among individuals with PTSD. 

“However, in this comorbid PTSD and CUD sample, sustained cannabis abstinence was associated with symptom improvement, thereby challenging assumptions about its clinical utility in this population,” they wrote. 

Interestingly, they added that there were no differential effects on reexperiencing symptoms such as flashbacks, intrusive memories, and nightmares. Both abstinent and nonabstinent participants reported similar improvements in reexperiencing, suggesting that factors unrelated to cannabis use may have contributed to symptom change or insufficient power, the authors said. 

The researchers called for larger randomized trials to “replicate and extend” these preliminary findings and to investigate mechanisms through which abstinence may relate to symptom changes in PTSD with CUD.

The study had no commercial funding. The authors had no relevant disclosures.

A version of this article first appeared on Medscape.com.

New research challenges the assumption that long-term cannabis use improves symptoms or functioning in posttraumatic stress disorder (PTSD).

On the contrary, researchers found that abstaining from cannabis for 3 months was associated with significantly greater reductions in PTSD symptoms in adults with PTSD and comorbid cannabis use disorder (CUD).

The data suggest that continued cannabis use could limit recovery in some domains — underscoring the need to routinely assess cannabis use during PTSD treatment and to educate patients on the potential consequences of continued use, the researchers said. 

The study was published online February 18 in the Journal of Clinical Psychiatry. 

Helpful or Harmful? 

PTSD is a debilitating psychiatric condition marked by intrusive memories, avoidance, negative changes in mood and cognition, and hyperarousal. Many patients turn to cannabis to ease symptoms. In one recent study, roughly 28% of individuals with PTSD reported past-year cannabis use and 9% met criteria for CUD. 

Although some studies have suggested PTSD symptom reduction with cannabis or cannabinoid-based treatments, others have identified potential risks, such as disrupted fear-extinction learning and worse clinical and treatment outcomes. 

A recent systematic review found mixed evidence overall, with six studies suggesting benefits, five reporting worsening of symptoms, and three showing no significant impact of cannabis use in the setting of PTSD.

Led by Ahmed Hassan, MD, University of Toronto, Ontario, the researchers recruited adults aged 18-65 years with confirmed PTSD and CUD through the Centre for Addiction and Mental Health in Toronto and asked them to discontinue cannabis for 12 weeks.

Abstinence was defined as a urine 11-nor-9-carboxy-tetrahydrocannabinol level of 50 ng/mL or lower with no self-reported use, verified at multiple timepoints. Participants received escalating cash incentives for remaining abstinent at weeks 4, 8, and 12.

Eleven (52%) of the 21 participants who completed the 12-week protocol achieved biochemically verified abstinence, while 10 did not.

Those who achieved abstinence reported significantly greater reductions in total PTSD symptom severity and symptom count compared to those who did not. 

Total severity scores on the Clinician-Administered PTSD Scale for DSM-5 dropped from 36.2 at baseline to 10.5 at week 12 among abstainers vs 34.6 to 21.8 among those who did not maintain abstinence (P = .001).

A similar pattern emerged for total symptom count, with abstinent participants dropping from 14.3 symptoms at baseline to 4.1 at week 12, compared to a decrease from 13.5 to 8.9 among nonabstainers.

Notably, the investigators observed that individuals who remained abstinent showed greater reductions in several core symptom clusters, including avoidance, negative alterations in mood, cognition, and hyperarousal — domains that are often cited as targets for cannabis-based self-medication among individuals with PTSD. 

“However, in this comorbid PTSD and CUD sample, sustained cannabis abstinence was associated with symptom improvement, thereby challenging assumptions about its clinical utility in this population,” they wrote. 

Interestingly, they added that there were no differential effects on reexperiencing symptoms such as flashbacks, intrusive memories, and nightmares. Both abstinent and nonabstinent participants reported similar improvements in reexperiencing, suggesting that factors unrelated to cannabis use may have contributed to symptom change or insufficient power, the authors said. 

The researchers called for larger randomized trials to “replicate and extend” these preliminary findings and to investigate mechanisms through which abstinence may relate to symptom changes in PTSD with CUD.

The study had no commercial funding. The authors had no relevant disclosures.

A version of this article first appeared on Medscape.com.

New research challenges the assumption that long-term cannabis use improves symptoms or functioning in posttraumatic stress disorder (PTSD).

On the contrary, researchers found that abstaining from cannabis for 3 months was associated with significantly greater reductions in PTSD symptoms in adults with PTSD and comorbid cannabis use disorder (CUD).

The data suggest that continued cannabis use could limit recovery in some domains — underscoring the need to routinely assess cannabis use during PTSD treatment and to educate patients on the potential consequences of continued use, the researchers said. 

The study was published online February 18 in the Journal of Clinical Psychiatry. 

Helpful or Harmful? 

PTSD is a debilitating psychiatric condition marked by intrusive memories, avoidance, negative changes in mood and cognition, and hyperarousal. Many patients turn to cannabis to ease symptoms. In one recent study, roughly 28% of individuals with PTSD reported past-year cannabis use and 9% met criteria for CUD. 

Although some studies have suggested PTSD symptom reduction with cannabis or cannabinoid-based treatments, others have identified potential risks, such as disrupted fear-extinction learning and worse clinical and treatment outcomes. 

A recent systematic review found mixed evidence overall, with six studies suggesting benefits, five reporting worsening of symptoms, and three showing no significant impact of cannabis use in the setting of PTSD.

Led by Ahmed Hassan, MD, University of Toronto, Ontario, the researchers recruited adults aged 18-65 years with confirmed PTSD and CUD through the Centre for Addiction and Mental Health in Toronto and asked them to discontinue cannabis for 12 weeks.

Abstinence was defined as a urine 11-nor-9-carboxy-tetrahydrocannabinol level of 50 ng/mL or lower with no self-reported use, verified at multiple timepoints. Participants received escalating cash incentives for remaining abstinent at weeks 4, 8, and 12.

Eleven (52%) of the 21 participants who completed the 12-week protocol achieved biochemically verified abstinence, while 10 did not.

Those who achieved abstinence reported significantly greater reductions in total PTSD symptom severity and symptom count compared to those who did not. 

Total severity scores on the Clinician-Administered PTSD Scale for DSM-5 dropped from 36.2 at baseline to 10.5 at week 12 among abstainers vs 34.6 to 21.8 among those who did not maintain abstinence (P = .001).

A similar pattern emerged for total symptom count, with abstinent participants dropping from 14.3 symptoms at baseline to 4.1 at week 12, compared to a decrease from 13.5 to 8.9 among nonabstainers.

Notably, the investigators observed that individuals who remained abstinent showed greater reductions in several core symptom clusters, including avoidance, negative alterations in mood, cognition, and hyperarousal — domains that are often cited as targets for cannabis-based self-medication among individuals with PTSD. 

“However, in this comorbid PTSD and CUD sample, sustained cannabis abstinence was associated with symptom improvement, thereby challenging assumptions about its clinical utility in this population,” they wrote. 

Interestingly, they added that there were no differential effects on reexperiencing symptoms such as flashbacks, intrusive memories, and nightmares. Both abstinent and nonabstinent participants reported similar improvements in reexperiencing, suggesting that factors unrelated to cannabis use may have contributed to symptom change or insufficient power, the authors said. 

The researchers called for larger randomized trials to “replicate and extend” these preliminary findings and to investigate mechanisms through which abstinence may relate to symptom changes in PTSD with CUD.

The study had no commercial funding. The authors had no relevant disclosures.

A version of this article first appeared on Medscape.com.

US service members and veterans were less likely to die than the general population from most causes of death over a 17-year period, a population-based, prospective analysis found. But there was a glaring exception: suicide by firearm.

Among 201,618 subjects tracked from 2001 to 2018 by the Millennium Cohort Study, the overall death rate was less than half that of a comparable group of US adults (standardized mortality ratios [SMR], 0.44), reported Edward J. Boyko, MD, MPH, staff physician with the Veterans Affairs (VA) Puget Sound Health Care System and professor of medicine at the University of Washington, Seattle, and colleagues in BMC Public Health. However, suicides by firearm—while rare—were more common overall (SMR, 1.42), among military men only (SMR, 1.33), and among military women only (SMR, 2.83) than civilians. 

The findings about the overall death rate may reflect the better health of those who join the military and have access to health care during and after service, Boyko told Federal Practitioner. The suicide data may reflect higher access to firearms, he said, although “more research is needed to identify what types of military exposures or physical and mental health predictors are associated with increased mortality risk due to suicide.”

The ongoing Millennium Cohort Study began in 2001 to track the health of military personnel over time. The study has spawned > 180 reports “used to inform and guide policy, guidelines, and health promotion efforts within the military and VA,” Boyko said. “As the Millennium Cohort Study approaches its 25-year anniversary, it seemed like an ideal time to assess mortality, especially cause-specific mortality, as a way to measure the impact of military service on long-term health.”

The analysis tracks 4 panels of subjects enrolled at various times between 2001 and 2013. Of the 201,619 participants, 3018 (1.5%) died by 2018. Of the 198,01 nondeceased participants, 69.2% were male; 8.1% were born before 1960, 16.1% were born from 1960 to 1969, 24.4% were born from 1970 to 1979, and 51.5% were born in or after 1980. The racial/ethnic makeup was 72.7% non-Hispanic White, 12.2% non-Hispanic Black, 7.9% Hispanic, and 7.1% other. Two-thirds (66.4%) were active duty, and 33.6% were in the Reserve or National Guard.

Of the 3018 deceased participants, 81.2% were male. In terms of birth year, 32.4% were born before 1960, 22.1% were born from 1960 to 1969, 18.2% were born from 1970 to 1979, and 27.3% were born in or after 1980. The racial/ethnic makeup was 77.7% non-Hispanic White, 11.9% non-Hispanic Black, 5.5% Hispanic, and 4.9% other. About half (51.0%) were active duty, and 49.0% were in the Reserve or National Guard.

Most deaths were due to natural causes (57.0%), followed by accident (20.1%), suicide (17.1%), operations of war (3.0%), homicide (2.1%), and other causes (1.2%). The new report noted that the Millennium Cohort Study and other research have identified a “healthy soldier effect, in which military populations tend to be healthier than the general US population.”

Boyko explained that “the fitness requirements for joining the military may favor the selection of healthier individuals from the general population. Another benefit of military service is free access to health care, especially among those on active duty, as well as eligibility for VA health care and other benefits after leaving service. This would allow for greater access to preventive care and treatments, as well as routine screening for health conditions such as cancer, diabetes, or cardiovascular disease.”

Overall suicide rates were higher among female subjects than among civilians (SMR, 1.65), but no statistically significant difference was seen in men (SMR, 0.96) or across all participants (SMR, 1.03). Regarding the large gaps in firearm suicide rates in military subjects vs civilians, Boyko said, “accessibility and familiarity with firearms, a highly lethal means of suicide, may be driving the elevated risk of suicide by firearms … prior research has found that unsecure firearms storage—such as unlocked, loaded firearms—increases the risk of suicide by firearms.”

Rachel Sayko Adams, PhD, MPH, a research associate professor with the Department of Health Law, Policy and Management at Boston University School of Public Health, is familiar with the study findings. Adams, a principal investigator at the VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, told Federal Practitioner that “efforts to further develop suicide prevention programs that consider the unique needs and preferences of female service members and veterans are critical to prevent future suicide mortality in this population.”

Adams added: “Just because service members and veterans have a lower all-cause mortality rate compared to the general US population, we should not assume that they are universally low risk or that we can reduce our public health prevention efforts targeting this population.”

Boyko highlighted KeepItSecure.net, which “helps veterans and service members protect themselves and their families by making it easier to store firearms securely during stressful or high-risk periods.” The site offers practical, judgment-free guidance with powerful storytelling and public outreach, with clear, actionable steps—such as using a cable gun lock or lockbox—to lower suicide risk long before a crisis occurs. The VA, Boyko said, provides free cable gun locks nationwide.

The Millennium Cohort Study is funded by the Department of Veterans Affairs and Department of Defense Military Operational Medicine Research Program and Defense Health Program. The report authors and Adams have no disclosures. 

US service members and veterans were less likely to die than the general population from most causes of death over a 17-year period, a population-based, prospective analysis found. But there was a glaring exception: suicide by firearm.

Among 201,618 subjects tracked from 2001 to 2018 by the Millennium Cohort Study, the overall death rate was less than half that of a comparable group of US adults (standardized mortality ratios [SMR], 0.44), reported Edward J. Boyko, MD, MPH, staff physician with the Veterans Affairs (VA) Puget Sound Health Care System and professor of medicine at the University of Washington, Seattle, and colleagues in BMC Public Health. However, suicides by firearm—while rare—were more common overall (SMR, 1.42), among military men only (SMR, 1.33), and among military women only (SMR, 2.83) than civilians. 

The findings about the overall death rate may reflect the better health of those who join the military and have access to health care during and after service, Boyko told Federal Practitioner. The suicide data may reflect higher access to firearms, he said, although “more research is needed to identify what types of military exposures or physical and mental health predictors are associated with increased mortality risk due to suicide.”

The ongoing Millennium Cohort Study began in 2001 to track the health of military personnel over time. The study has spawned > 180 reports “used to inform and guide policy, guidelines, and health promotion efforts within the military and VA,” Boyko said. “As the Millennium Cohort Study approaches its 25-year anniversary, it seemed like an ideal time to assess mortality, especially cause-specific mortality, as a way to measure the impact of military service on long-term health.”

The analysis tracks 4 panels of subjects enrolled at various times between 2001 and 2013. Of the 201,619 participants, 3018 (1.5%) died by 2018. Of the 198,01 nondeceased participants, 69.2% were male; 8.1% were born before 1960, 16.1% were born from 1960 to 1969, 24.4% were born from 1970 to 1979, and 51.5% were born in or after 1980. The racial/ethnic makeup was 72.7% non-Hispanic White, 12.2% non-Hispanic Black, 7.9% Hispanic, and 7.1% other. Two-thirds (66.4%) were active duty, and 33.6% were in the Reserve or National Guard.

Of the 3018 deceased participants, 81.2% were male. In terms of birth year, 32.4% were born before 1960, 22.1% were born from 1960 to 1969, 18.2% were born from 1970 to 1979, and 27.3% were born in or after 1980. The racial/ethnic makeup was 77.7% non-Hispanic White, 11.9% non-Hispanic Black, 5.5% Hispanic, and 4.9% other. About half (51.0%) were active duty, and 49.0% were in the Reserve or National Guard.

Most deaths were due to natural causes (57.0%), followed by accident (20.1%), suicide (17.1%), operations of war (3.0%), homicide (2.1%), and other causes (1.2%). The new report noted that the Millennium Cohort Study and other research have identified a “healthy soldier effect, in which military populations tend to be healthier than the general US population.”

Boyko explained that “the fitness requirements for joining the military may favor the selection of healthier individuals from the general population. Another benefit of military service is free access to health care, especially among those on active duty, as well as eligibility for VA health care and other benefits after leaving service. This would allow for greater access to preventive care and treatments, as well as routine screening for health conditions such as cancer, diabetes, or cardiovascular disease.”

Overall suicide rates were higher among female subjects than among civilians (SMR, 1.65), but no statistically significant difference was seen in men (SMR, 0.96) or across all participants (SMR, 1.03). Regarding the large gaps in firearm suicide rates in military subjects vs civilians, Boyko said, “accessibility and familiarity with firearms, a highly lethal means of suicide, may be driving the elevated risk of suicide by firearms … prior research has found that unsecure firearms storage—such as unlocked, loaded firearms—increases the risk of suicide by firearms.”

Rachel Sayko Adams, PhD, MPH, a research associate professor with the Department of Health Law, Policy and Management at Boston University School of Public Health, is familiar with the study findings. Adams, a principal investigator at the VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, told Federal Practitioner that “efforts to further develop suicide prevention programs that consider the unique needs and preferences of female service members and veterans are critical to prevent future suicide mortality in this population.”

Adams added: “Just because service members and veterans have a lower all-cause mortality rate compared to the general US population, we should not assume that they are universally low risk or that we can reduce our public health prevention efforts targeting this population.”

Boyko highlighted KeepItSecure.net, which “helps veterans and service members protect themselves and their families by making it easier to store firearms securely during stressful or high-risk periods.” The site offers practical, judgment-free guidance with powerful storytelling and public outreach, with clear, actionable steps—such as using a cable gun lock or lockbox—to lower suicide risk long before a crisis occurs. The VA, Boyko said, provides free cable gun locks nationwide.

The Millennium Cohort Study is funded by the Department of Veterans Affairs and Department of Defense Military Operational Medicine Research Program and Defense Health Program. The report authors and Adams have no disclosures. 

US service members and veterans were less likely to die than the general population from most causes of death over a 17-year period, a population-based, prospective analysis found. But there was a glaring exception: suicide by firearm.

Among 201,618 subjects tracked from 2001 to 2018 by the Millennium Cohort Study, the overall death rate was less than half that of a comparable group of US adults (standardized mortality ratios [SMR], 0.44), reported Edward J. Boyko, MD, MPH, staff physician with the Veterans Affairs (VA) Puget Sound Health Care System and professor of medicine at the University of Washington, Seattle, and colleagues in BMC Public Health. However, suicides by firearm—while rare—were more common overall (SMR, 1.42), among military men only (SMR, 1.33), and among military women only (SMR, 2.83) than civilians. 

The findings about the overall death rate may reflect the better health of those who join the military and have access to health care during and after service, Boyko told Federal Practitioner. The suicide data may reflect higher access to firearms, he said, although “more research is needed to identify what types of military exposures or physical and mental health predictors are associated with increased mortality risk due to suicide.”

The ongoing Millennium Cohort Study began in 2001 to track the health of military personnel over time. The study has spawned > 180 reports “used to inform and guide policy, guidelines, and health promotion efforts within the military and VA,” Boyko said. “As the Millennium Cohort Study approaches its 25-year anniversary, it seemed like an ideal time to assess mortality, especially cause-specific mortality, as a way to measure the impact of military service on long-term health.”

The analysis tracks 4 panels of subjects enrolled at various times between 2001 and 2013. Of the 201,619 participants, 3018 (1.5%) died by 2018. Of the 198,01 nondeceased participants, 69.2% were male; 8.1% were born before 1960, 16.1% were born from 1960 to 1969, 24.4% were born from 1970 to 1979, and 51.5% were born in or after 1980. The racial/ethnic makeup was 72.7% non-Hispanic White, 12.2% non-Hispanic Black, 7.9% Hispanic, and 7.1% other. Two-thirds (66.4%) were active duty, and 33.6% were in the Reserve or National Guard.

Of the 3018 deceased participants, 81.2% were male. In terms of birth year, 32.4% were born before 1960, 22.1% were born from 1960 to 1969, 18.2% were born from 1970 to 1979, and 27.3% were born in or after 1980. The racial/ethnic makeup was 77.7% non-Hispanic White, 11.9% non-Hispanic Black, 5.5% Hispanic, and 4.9% other. About half (51.0%) were active duty, and 49.0% were in the Reserve or National Guard.

Most deaths were due to natural causes (57.0%), followed by accident (20.1%), suicide (17.1%), operations of war (3.0%), homicide (2.1%), and other causes (1.2%). The new report noted that the Millennium Cohort Study and other research have identified a “healthy soldier effect, in which military populations tend to be healthier than the general US population.”

Boyko explained that “the fitness requirements for joining the military may favor the selection of healthier individuals from the general population. Another benefit of military service is free access to health care, especially among those on active duty, as well as eligibility for VA health care and other benefits after leaving service. This would allow for greater access to preventive care and treatments, as well as routine screening for health conditions such as cancer, diabetes, or cardiovascular disease.”

Overall suicide rates were higher among female subjects than among civilians (SMR, 1.65), but no statistically significant difference was seen in men (SMR, 0.96) or across all participants (SMR, 1.03). Regarding the large gaps in firearm suicide rates in military subjects vs civilians, Boyko said, “accessibility and familiarity with firearms, a highly lethal means of suicide, may be driving the elevated risk of suicide by firearms … prior research has found that unsecure firearms storage—such as unlocked, loaded firearms—increases the risk of suicide by firearms.”

Rachel Sayko Adams, PhD, MPH, a research associate professor with the Department of Health Law, Policy and Management at Boston University School of Public Health, is familiar with the study findings. Adams, a principal investigator at the VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, told Federal Practitioner that “efforts to further develop suicide prevention programs that consider the unique needs and preferences of female service members and veterans are critical to prevent future suicide mortality in this population.”

Adams added: “Just because service members and veterans have a lower all-cause mortality rate compared to the general US population, we should not assume that they are universally low risk or that we can reduce our public health prevention efforts targeting this population.”

Boyko highlighted KeepItSecure.net, which “helps veterans and service members protect themselves and their families by making it easier to store firearms securely during stressful or high-risk periods.” The site offers practical, judgment-free guidance with powerful storytelling and public outreach, with clear, actionable steps—such as using a cable gun lock or lockbox—to lower suicide risk long before a crisis occurs. The VA, Boyko said, provides free cable gun locks nationwide.

The Millennium Cohort Study is funded by the Department of Veterans Affairs and Department of Defense Military Operational Medicine Research Program and Defense Health Program. The report authors and Adams have no disclosures. 

Fewer veterans died by suicide in 2023 than 2022, according to the recently released 2025 National Veteran Suicide Prevention Annual Report from the US Department of Veterans Affairs (VA).

More than half of suicides, the Veterans Health Administration (VHA) found, were driven by pain (52.3%) or sleep problems (51.5%). Increased health problems were factors in 43.1% of cases, particularly traumatic brain injury (TBI) and cancer diagnosis. The suicide rate was 77.6 per 100,000 for veterans with a recent diagnosis of TBI, 94.3% higher than the rate of individuals without such a diagnosis. The suicide rate following a cancer diagnosis was 10.3% higher than for other veterans in VHA care—emphasizing the need, according to the VHA, to continue to expand efforts to integrate suicide prevention resources across all areas serving high-risk veteran groups.

VA has published the National Veteran Suicide Prevention report annually since 2016, with its release typically occurring in December. Release of the 2025 report was delayed until February 2026. The VA attributed the delay, however, due to the federal government shutdown from October 1 to November 12, 2025. At a January 2026 Senate Veterans’ Affairs Committee hearing, VA Secretary Doug Collins denied that there was an effort to halt its release.

Veteran deaths by suicide have often been called an epidemic, with the suicide rate having risen faster for veterans than it has for nonveterans since 2005. Veterans are 1.5 times more likely to die by suicide, a statistic that led Collins, veteran advocates, and members of Congress to identify veteran suicide prevention as a top priority.

The report indicates that the number of veteran suicides per year has remained relatively constant in the 6 most recent years of available data: 6738 in 2018, 6510 in 2019, 6347 in 2020, 6429 in 2021, 6442 in 2022, and 6398 in 2023. The fewest veteran suicides in the last 25 years happened both in 2001 and 2004 (6021), while the most (6738) came in 2018.

Although the overall veteran population has declined over time, more veterans are enrolling in VHA care, increasing from 3.8 million in 2001 to 6.1 million in 2023. However, the VHA found that 61% of veterans who died by suicide in 2023 were not receiving VHA care in the final year of their life.

The suicide rate among veterans in VHA care with mental health or substance use disorder diagnoses fell 34.7%, highlighting “the importance of both strengthening VA’s direct care system and expanding outreach and suicide prevention efforts for veterans who are not engaged in VHA health care,” Sen. Richard Blumenthal (D-CT), Ranking Member on the Senate Veterans’ Affairs Committee, said in a Feb. 5 statement about the report. 

Aligning with previous VA data, the report presented information suggesting VHA services such as the Veterans Crisis Line (VCL) may reduce veteran suicide rates. Twelve months after the first contact with the VCL, the suicide rate for veterans in VHA care in 2022 was 16.1% lower than for those in 2021. 

More than 2800 local and state coalitions are “actively working to meet community needs, expand available resources, and raise awareness” about suicide risks and prevention, the report says. The Staff Sergeant Parker Gordon Fox Suicide Prevention Grants Program, for example, provides community-based services for veterans, service members, and their families.

“Veteran suicide has been a scourge on our nation for far too long,” Collins said in a press release. “Most veterans who die by suicide were not in recent VA care, so making it easier for those who have worn the uniform to access the VA benefits they have earned is key.”

Fewer veterans died by suicide in 2023 than 2022, according to the recently released 2025 National Veteran Suicide Prevention Annual Report from the US Department of Veterans Affairs (VA).

More than half of suicides, the Veterans Health Administration (VHA) found, were driven by pain (52.3%) or sleep problems (51.5%). Increased health problems were factors in 43.1% of cases, particularly traumatic brain injury (TBI) and cancer diagnosis. The suicide rate was 77.6 per 100,000 for veterans with a recent diagnosis of TBI, 94.3% higher than the rate of individuals without such a diagnosis. The suicide rate following a cancer diagnosis was 10.3% higher than for other veterans in VHA care—emphasizing the need, according to the VHA, to continue to expand efforts to integrate suicide prevention resources across all areas serving high-risk veteran groups.

VA has published the National Veteran Suicide Prevention report annually since 2016, with its release typically occurring in December. Release of the 2025 report was delayed until February 2026. The VA attributed the delay, however, due to the federal government shutdown from October 1 to November 12, 2025. At a January 2026 Senate Veterans’ Affairs Committee hearing, VA Secretary Doug Collins denied that there was an effort to halt its release.

Veteran deaths by suicide have often been called an epidemic, with the suicide rate having risen faster for veterans than it has for nonveterans since 2005. Veterans are 1.5 times more likely to die by suicide, a statistic that led Collins, veteran advocates, and members of Congress to identify veteran suicide prevention as a top priority.

The report indicates that the number of veteran suicides per year has remained relatively constant in the 6 most recent years of available data: 6738 in 2018, 6510 in 2019, 6347 in 2020, 6429 in 2021, 6442 in 2022, and 6398 in 2023. The fewest veteran suicides in the last 25 years happened both in 2001 and 2004 (6021), while the most (6738) came in 2018.

Although the overall veteran population has declined over time, more veterans are enrolling in VHA care, increasing from 3.8 million in 2001 to 6.1 million in 2023. However, the VHA found that 61% of veterans who died by suicide in 2023 were not receiving VHA care in the final year of their life.

The suicide rate among veterans in VHA care with mental health or substance use disorder diagnoses fell 34.7%, highlighting “the importance of both strengthening VA’s direct care system and expanding outreach and suicide prevention efforts for veterans who are not engaged in VHA health care,” Sen. Richard Blumenthal (D-CT), Ranking Member on the Senate Veterans’ Affairs Committee, said in a Feb. 5 statement about the report. 

Aligning with previous VA data, the report presented information suggesting VHA services such as the Veterans Crisis Line (VCL) may reduce veteran suicide rates. Twelve months after the first contact with the VCL, the suicide rate for veterans in VHA care in 2022 was 16.1% lower than for those in 2021. 

More than 2800 local and state coalitions are “actively working to meet community needs, expand available resources, and raise awareness” about suicide risks and prevention, the report says. The Staff Sergeant Parker Gordon Fox Suicide Prevention Grants Program, for example, provides community-based services for veterans, service members, and their families.

“Veteran suicide has been a scourge on our nation for far too long,” Collins said in a press release. “Most veterans who die by suicide were not in recent VA care, so making it easier for those who have worn the uniform to access the VA benefits they have earned is key.”

Fewer veterans died by suicide in 2023 than 2022, according to the recently released 2025 National Veteran Suicide Prevention Annual Report from the US Department of Veterans Affairs (VA).

More than half of suicides, the Veterans Health Administration (VHA) found, were driven by pain (52.3%) or sleep problems (51.5%). Increased health problems were factors in 43.1% of cases, particularly traumatic brain injury (TBI) and cancer diagnosis. The suicide rate was 77.6 per 100,000 for veterans with a recent diagnosis of TBI, 94.3% higher than the rate of individuals without such a diagnosis. The suicide rate following a cancer diagnosis was 10.3% higher than for other veterans in VHA care—emphasizing the need, according to the VHA, to continue to expand efforts to integrate suicide prevention resources across all areas serving high-risk veteran groups.

VA has published the National Veteran Suicide Prevention report annually since 2016, with its release typically occurring in December. Release of the 2025 report was delayed until February 2026. The VA attributed the delay, however, due to the federal government shutdown from October 1 to November 12, 2025. At a January 2026 Senate Veterans’ Affairs Committee hearing, VA Secretary Doug Collins denied that there was an effort to halt its release.

Veteran deaths by suicide have often been called an epidemic, with the suicide rate having risen faster for veterans than it has for nonveterans since 2005. Veterans are 1.5 times more likely to die by suicide, a statistic that led Collins, veteran advocates, and members of Congress to identify veteran suicide prevention as a top priority.

The report indicates that the number of veteran suicides per year has remained relatively constant in the 6 most recent years of available data: 6738 in 2018, 6510 in 2019, 6347 in 2020, 6429 in 2021, 6442 in 2022, and 6398 in 2023. The fewest veteran suicides in the last 25 years happened both in 2001 and 2004 (6021), while the most (6738) came in 2018.

Although the overall veteran population has declined over time, more veterans are enrolling in VHA care, increasing from 3.8 million in 2001 to 6.1 million in 2023. However, the VHA found that 61% of veterans who died by suicide in 2023 were not receiving VHA care in the final year of their life.

The suicide rate among veterans in VHA care with mental health or substance use disorder diagnoses fell 34.7%, highlighting “the importance of both strengthening VA’s direct care system and expanding outreach and suicide prevention efforts for veterans who are not engaged in VHA health care,” Sen. Richard Blumenthal (D-CT), Ranking Member on the Senate Veterans’ Affairs Committee, said in a Feb. 5 statement about the report. 

Aligning with previous VA data, the report presented information suggesting VHA services such as the Veterans Crisis Line (VCL) may reduce veteran suicide rates. Twelve months after the first contact with the VCL, the suicide rate for veterans in VHA care in 2022 was 16.1% lower than for those in 2021. 

More than 2800 local and state coalitions are “actively working to meet community needs, expand available resources, and raise awareness” about suicide risks and prevention, the report says. The Staff Sergeant Parker Gordon Fox Suicide Prevention Grants Program, for example, provides community-based services for veterans, service members, and their families.

“Veteran suicide has been a scourge on our nation for far too long,” Collins said in a press release. “Most veterans who die by suicide were not in recent VA care, so making it easier for those who have worn the uniform to access the VA benefits they have earned is key.”

Spending time in a war zone can lead to chronic mental and physical pain. Now, research points to a link between two common disorders that can leave service members struggling.

Published in the journal Arthritis Care & Research, a longitudinal cohort study of 1761 US military service members found that those who had posttraumatic stress disorder (PTSD) before deployment were nearly 3times more likely to develop fibromyalgia after returning home (odds ratio, 2.96; 95% CI, 2.08-4.22). Those with fibromyalgia before deployment had more than threefold greater likelihood of developing PTSD after deployment (odds ratio, 3.12; 95% CI, 1.63-5.95).

This is the largest prospective study to date linking the stress of combat deployment to the onset of fibromyalgia.

“We had the advantage of observing a large population before and after exposure to an environment that often involves significant stress,” said lead study author Jay Higgs, MD, a retired rheumatologist with Brooke Army Medical Center and the University of Texas Health Science Center at San Antonio.

Here’s what the team found and why it matters.

Significant Increase in Fibromyalgia After Development

Service members were checked for fibromyalgia using the 2011 questionnaire modification of the 2010 American College of Rheumatology preliminary diagnostic criteria for fibromyalgia. They were assessed for PTSD using the PTSD Checklist Stressor-Specific Version.

Before deployment, service members had similar rates of fibromyalgia as the general population: 2.2% in men and 2.0% in women. After deployment, fibromyalgia rates increased significantly to 8.0% in men and 11.1% in women.

While fibromyalgia tends to be underreported in men, the findings suggest it should not be overlooked in this population. “Our results are consistent with the notion that there should be no gender bias when considering the possibility of fibromyalgia in an individual patient,” Higgs said.

Before deployment, 20.7% of men and 18.3% of women had PTSD symptoms. After deployment, the PTSD rate increased slightly to 22.7% in men and 25.5% in women.

The Link Between Fibromyalgia and PTSD

The researchers said the results suggest that PTSD and fibromyalgia might be linked through central nervous system mechanisms such as central sensitization, elevated hypothalamic-pituitary-adrenal axis activity, elevated cortisol, and proinflammatory cytokines. However, shared causation, associated risk factors, selection bias, or alternative mechanisms within the central and peripheral neuroendocrine and cytokine systems could also be part of the story.

“What we do not know is how much of what we see clinically represents central nervous system pathology, peripheral problems, or a combination of the 2,” Higgs said. “Neurotransmission in the central nervous system is highly complex, and may not only involve specific structures, but a web of communications between them.”

Loci in the midbrain appear especially important, he said.

Elizabeth Hoge, MD, professor and director of the Anxiety Disorders Research Program at Georgetown University School of Medicine, Washington, DC, said that patients with PTSD often have pain, headaches, sleep disturbances, and other symptoms that are part of the picture of fibromyalgia. It’s plausible that pain syndromes could be manifestations of PTSD or groupings of symptoms that suggest a subtype.

“Pain is one way that people experience distress, and we know that in PTSD, sometimes the trauma memories are encoded too strongly, more stressful and more alarming to the body system,” she said.

When patients have symptoms such as chronic pain, headaches, fatigue, or cognitive brain fog, clinicians should remember to ask about trauma exposure, Hoge said. You might be the first to broach the subject.

“I’ve certainly seen patients in clinic who never get asked about the exposure to trauma, including sexual trauma, so sometimes that can be the first pathway to helping people feel better is just to have their trauma recognized,” Hoge said.

If a patient has experienced or witnessed violence, consider a referral to a psychiatrist or psychologist to evaluate them for PTSD. Higgs said he collaborated closely with a psychologist to complement his treatment plans for active duty and retired military service members and families.

The US Department of Veterans Affairs and the Department of Defense (DoD) recommend trauma-focused psychotherapy as the first line of treatment for PTSD. This form of therapy deliberately focuses on bringing trauma memories into the open, Hoge said.

“When a person talks about their trauma, and it comes into direct consciousness, somehow it’s malleable, and so when it goes back down into the memory banks, it’s changed somewhat,” she said.

This study was supported by the DoD through awards from the US Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, and Psychological Health and Traumatic Brain Injury Research Program. The funding organizations played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Higgs’s comments are his own and do not necessarily reflect the official policy or position of the Defense Health Agency, Brooke Army Medical Center, Carl R. Darnall Army Medical Center, the DoD, the Department of Veterans Affairs, or any agencies under the US government. Hoge had no relevant disclosures.

A version of this article first appeared on Medscape.com.

Spending time in a war zone can lead to chronic mental and physical pain. Now, research points to a link between two common disorders that can leave service members struggling.

Published in the journal Arthritis Care & Research, a longitudinal cohort study of 1761 US military service members found that those who had posttraumatic stress disorder (PTSD) before deployment were nearly 3times more likely to develop fibromyalgia after returning home (odds ratio, 2.96; 95% CI, 2.08-4.22). Those with fibromyalgia before deployment had more than threefold greater likelihood of developing PTSD after deployment (odds ratio, 3.12; 95% CI, 1.63-5.95).

This is the largest prospective study to date linking the stress of combat deployment to the onset of fibromyalgia.

“We had the advantage of observing a large population before and after exposure to an environment that often involves significant stress,” said lead study author Jay Higgs, MD, a retired rheumatologist with Brooke Army Medical Center and the University of Texas Health Science Center at San Antonio.

Here’s what the team found and why it matters.

Significant Increase in Fibromyalgia After Development

Service members were checked for fibromyalgia using the 2011 questionnaire modification of the 2010 American College of Rheumatology preliminary diagnostic criteria for fibromyalgia. They were assessed for PTSD using the PTSD Checklist Stressor-Specific Version.

Before deployment, service members had similar rates of fibromyalgia as the general population: 2.2% in men and 2.0% in women. After deployment, fibromyalgia rates increased significantly to 8.0% in men and 11.1% in women.

While fibromyalgia tends to be underreported in men, the findings suggest it should not be overlooked in this population. “Our results are consistent with the notion that there should be no gender bias when considering the possibility of fibromyalgia in an individual patient,” Higgs said.

Before deployment, 20.7% of men and 18.3% of women had PTSD symptoms. After deployment, the PTSD rate increased slightly to 22.7% in men and 25.5% in women.

The Link Between Fibromyalgia and PTSD

The researchers said the results suggest that PTSD and fibromyalgia might be linked through central nervous system mechanisms such as central sensitization, elevated hypothalamic-pituitary-adrenal axis activity, elevated cortisol, and proinflammatory cytokines. However, shared causation, associated risk factors, selection bias, or alternative mechanisms within the central and peripheral neuroendocrine and cytokine systems could also be part of the story.

“What we do not know is how much of what we see clinically represents central nervous system pathology, peripheral problems, or a combination of the 2,” Higgs said. “Neurotransmission in the central nervous system is highly complex, and may not only involve specific structures, but a web of communications between them.”

Loci in the midbrain appear especially important, he said.

Elizabeth Hoge, MD, professor and director of the Anxiety Disorders Research Program at Georgetown University School of Medicine, Washington, DC, said that patients with PTSD often have pain, headaches, sleep disturbances, and other symptoms that are part of the picture of fibromyalgia. It’s plausible that pain syndromes could be manifestations of PTSD or groupings of symptoms that suggest a subtype.

“Pain is one way that people experience distress, and we know that in PTSD, sometimes the trauma memories are encoded too strongly, more stressful and more alarming to the body system,” she said.

When patients have symptoms such as chronic pain, headaches, fatigue, or cognitive brain fog, clinicians should remember to ask about trauma exposure, Hoge said. You might be the first to broach the subject.

“I’ve certainly seen patients in clinic who never get asked about the exposure to trauma, including sexual trauma, so sometimes that can be the first pathway to helping people feel better is just to have their trauma recognized,” Hoge said.

If a patient has experienced or witnessed violence, consider a referral to a psychiatrist or psychologist to evaluate them for PTSD. Higgs said he collaborated closely with a psychologist to complement his treatment plans for active duty and retired military service members and families.

The US Department of Veterans Affairs and the Department of Defense (DoD) recommend trauma-focused psychotherapy as the first line of treatment for PTSD. This form of therapy deliberately focuses on bringing trauma memories into the open, Hoge said.

“When a person talks about their trauma, and it comes into direct consciousness, somehow it’s malleable, and so when it goes back down into the memory banks, it’s changed somewhat,” she said.

This study was supported by the DoD through awards from the US Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, and Psychological Health and Traumatic Brain Injury Research Program. The funding organizations played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Higgs’s comments are his own and do not necessarily reflect the official policy or position of the Defense Health Agency, Brooke Army Medical Center, Carl R. Darnall Army Medical Center, the DoD, the Department of Veterans Affairs, or any agencies under the US government. Hoge had no relevant disclosures.

A version of this article first appeared on Medscape.com.

Spending time in a war zone can lead to chronic mental and physical pain. Now, research points to a link between two common disorders that can leave service members struggling.

Published in the journal Arthritis Care & Research, a longitudinal cohort study of 1761 US military service members found that those who had posttraumatic stress disorder (PTSD) before deployment were nearly 3times more likely to develop fibromyalgia after returning home (odds ratio, 2.96; 95% CI, 2.08-4.22). Those with fibromyalgia before deployment had more than threefold greater likelihood of developing PTSD after deployment (odds ratio, 3.12; 95% CI, 1.63-5.95).

This is the largest prospective study to date linking the stress of combat deployment to the onset of fibromyalgia.

“We had the advantage of observing a large population before and after exposure to an environment that often involves significant stress,” said lead study author Jay Higgs, MD, a retired rheumatologist with Brooke Army Medical Center and the University of Texas Health Science Center at San Antonio.

Here’s what the team found and why it matters.

Significant Increase in Fibromyalgia After Development

Service members were checked for fibromyalgia using the 2011 questionnaire modification of the 2010 American College of Rheumatology preliminary diagnostic criteria for fibromyalgia. They were assessed for PTSD using the PTSD Checklist Stressor-Specific Version.

Before deployment, service members had similar rates of fibromyalgia as the general population: 2.2% in men and 2.0% in women. After deployment, fibromyalgia rates increased significantly to 8.0% in men and 11.1% in women.

While fibromyalgia tends to be underreported in men, the findings suggest it should not be overlooked in this population. “Our results are consistent with the notion that there should be no gender bias when considering the possibility of fibromyalgia in an individual patient,” Higgs said.

Before deployment, 20.7% of men and 18.3% of women had PTSD symptoms. After deployment, the PTSD rate increased slightly to 22.7% in men and 25.5% in women.

The Link Between Fibromyalgia and PTSD

The researchers said the results suggest that PTSD and fibromyalgia might be linked through central nervous system mechanisms such as central sensitization, elevated hypothalamic-pituitary-adrenal axis activity, elevated cortisol, and proinflammatory cytokines. However, shared causation, associated risk factors, selection bias, or alternative mechanisms within the central and peripheral neuroendocrine and cytokine systems could also be part of the story.

“What we do not know is how much of what we see clinically represents central nervous system pathology, peripheral problems, or a combination of the 2,” Higgs said. “Neurotransmission in the central nervous system is highly complex, and may not only involve specific structures, but a web of communications between them.”

Loci in the midbrain appear especially important, he said.

Elizabeth Hoge, MD, professor and director of the Anxiety Disorders Research Program at Georgetown University School of Medicine, Washington, DC, said that patients with PTSD often have pain, headaches, sleep disturbances, and other symptoms that are part of the picture of fibromyalgia. It’s plausible that pain syndromes could be manifestations of PTSD or groupings of symptoms that suggest a subtype.

“Pain is one way that people experience distress, and we know that in PTSD, sometimes the trauma memories are encoded too strongly, more stressful and more alarming to the body system,” she said.

When patients have symptoms such as chronic pain, headaches, fatigue, or cognitive brain fog, clinicians should remember to ask about trauma exposure, Hoge said. You might be the first to broach the subject.

“I’ve certainly seen patients in clinic who never get asked about the exposure to trauma, including sexual trauma, so sometimes that can be the first pathway to helping people feel better is just to have their trauma recognized,” Hoge said.

If a patient has experienced or witnessed violence, consider a referral to a psychiatrist or psychologist to evaluate them for PTSD. Higgs said he collaborated closely with a psychologist to complement his treatment plans for active duty and retired military service members and families.

The US Department of Veterans Affairs and the Department of Defense (DoD) recommend trauma-focused psychotherapy as the first line of treatment for PTSD. This form of therapy deliberately focuses on bringing trauma memories into the open, Hoge said.

“When a person talks about their trauma, and it comes into direct consciousness, somehow it’s malleable, and so when it goes back down into the memory banks, it’s changed somewhat,” she said.

This study was supported by the DoD through awards from the US Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, and Psychological Health and Traumatic Brain Injury Research Program. The funding organizations played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Higgs’s comments are his own and do not necessarily reflect the official policy or position of the Defense Health Agency, Brooke Army Medical Center, Carl R. Darnall Army Medical Center, the DoD, the Department of Veterans Affairs, or any agencies under the US government. Hoge had no relevant disclosures.

A version of this article first appeared on Medscape.com.

Veterans experiencing unstable housing, financial strain, and with poor access to health care have a higher risk of suicidal thoughts and behaviors, according to findings in a new study, leading researchers to call for additional screening to identify those in jeopardy. 

Each incremental increase in social disadvantage was tied to increases in the likelihood of recent suicidal thoughts (odds ratio [OR], 2.14), future suicidal intent (OR, 2.21), and lifetime suicide attempt (OR, 1.78) in a weighted analysis. The self-reported data was published as a cross-sectional study by Pietrzak et al in the December 2025 issue of JAMA Psychiatry.

Veterans whose social plights ranked in the worst 5% were > 20 times more likely to report suicidal thoughts and behaviors than those in the top 5%. Especially striking were the magnitudes of the associations and their persistence after adjustment for psychiatric conditions and other suicide risk factors, lead author Robert H. Pietrzak, PhD, MPH said in an interview with Federal Practitioner.

“This finding highlights how extreme cumulative disadvantage can be overwhelming,” Pietrzak said. “It suggests that suicide risk among veterans increases dramatically when multiple social stressors cluster together. Rather than any single hardship driving risk, it is the cumulative impact of social disadvantage that appears most strongly linked to elevated suicide risk.”

As Pietrzak explained, veterans account for < 7% of total US adults but about 14% of suicide deaths. “Several factors may contribute to this difference, including higher exposure to trauma, elevated rates of psychiatric conditions, challenges with reintegration into civilian life, and structural barriers to care,” Pietrzak said. “Increasingly, social and economic stressors are also recognized by experts and researchers as critical contributors to suicide risk.”

Social determinants of health (SDOH) such as unemployment and lack of access to health care have also been linked to suicide risk, he said.

“Less well understood is how multiple adverse social conditions interact and accumulate to compound suicide risk,” Pietrzak said.

The new study sought to determine the impact of SDOH as a whole, not just in isolation. The study analyzed SDOH in 5 areas—education access and quality, economic conditions, health care access and quality, neighborhood and built environment, and social and community context—via the National Health and Resilience in Veterans Study, which surveyed 4069 veterans. The participants had weighted demographics of mean age 62.2 years; 90.2% were male; and 78.1% White, 11.2% Black, 6.6% Hispanic, 4.2% other.

Past-year suicidal ideation was most highly linked to psychosocial difficulties (OR, 1.58; 95% CI, 1.43-1.75). Future suicidal intent was most highly linked to residing in a mobile home, recreational vehicle, or van (OR, 1.60; 95% CI, 1.24-2.07) in addition to psychosocial difficulties (OR, 1.45; 95% CI, 1.18-1.80). Lifetime suicidal attempt was most highly linked to history of homelessness (OR, 1.37; 95% CI, 1.22-1.55; all P < .001).

“The results of our study underscore the importance of routine, standardized screening for cumulative social disadvantage within VA and community care settings that serve veterans,” Pietrzak said.

He added that findings make it clear that “suicide prevention extends beyond mental health care. Improving the social conditions in which veterans live, work, and age is not only good public policy. It may save lives.”

Mark S. Kaplan, DrPH, a research professor of Social Welfare at the University of California at Los Angeles Luskin School of Public Affairs is familiar with the study findings and said they highlight the need to “approach the question of suicide in much wider terms as opposed to reducing it to psychiatric traits.”

J. John Mann, MD, a professor of translational neuroscience in psychiatry and radiology who studies suicide at Columbia University, New York City, said the study’s findings illustrate that clinicians must do more to understand the lives of patients outside the examination room. He predicted that more screening for social determinants of health will “enrich the amount of information that the clinician will have and lead to a more comprehensive clinical care plan.”

The US Department of Veterans Affairs supported the study. Pietrzak has no disclosures. Other study authors report various disclosures.

Veterans experiencing unstable housing, financial strain, and with poor access to health care have a higher risk of suicidal thoughts and behaviors, according to findings in a new study, leading researchers to call for additional screening to identify those in jeopardy. 

Each incremental increase in social disadvantage was tied to increases in the likelihood of recent suicidal thoughts (odds ratio [OR], 2.14), future suicidal intent (OR, 2.21), and lifetime suicide attempt (OR, 1.78) in a weighted analysis. The self-reported data was published as a cross-sectional study by Pietrzak et al in the December 2025 issue of JAMA Psychiatry.

Veterans whose social plights ranked in the worst 5% were > 20 times more likely to report suicidal thoughts and behaviors than those in the top 5%. Especially striking were the magnitudes of the associations and their persistence after adjustment for psychiatric conditions and other suicide risk factors, lead author Robert H. Pietrzak, PhD, MPH said in an interview with Federal Practitioner.

“This finding highlights how extreme cumulative disadvantage can be overwhelming,” Pietrzak said. “It suggests that suicide risk among veterans increases dramatically when multiple social stressors cluster together. Rather than any single hardship driving risk, it is the cumulative impact of social disadvantage that appears most strongly linked to elevated suicide risk.”

As Pietrzak explained, veterans account for < 7% of total US adults but about 14% of suicide deaths. “Several factors may contribute to this difference, including higher exposure to trauma, elevated rates of psychiatric conditions, challenges with reintegration into civilian life, and structural barriers to care,” Pietrzak said. “Increasingly, social and economic stressors are also recognized by experts and researchers as critical contributors to suicide risk.”

Social determinants of health (SDOH) such as unemployment and lack of access to health care have also been linked to suicide risk, he said.

“Less well understood is how multiple adverse social conditions interact and accumulate to compound suicide risk,” Pietrzak said.

The new study sought to determine the impact of SDOH as a whole, not just in isolation. The study analyzed SDOH in 5 areas—education access and quality, economic conditions, health care access and quality, neighborhood and built environment, and social and community context—via the National Health and Resilience in Veterans Study, which surveyed 4069 veterans. The participants had weighted demographics of mean age 62.2 years; 90.2% were male; and 78.1% White, 11.2% Black, 6.6% Hispanic, 4.2% other.

Past-year suicidal ideation was most highly linked to psychosocial difficulties (OR, 1.58; 95% CI, 1.43-1.75). Future suicidal intent was most highly linked to residing in a mobile home, recreational vehicle, or van (OR, 1.60; 95% CI, 1.24-2.07) in addition to psychosocial difficulties (OR, 1.45; 95% CI, 1.18-1.80). Lifetime suicidal attempt was most highly linked to history of homelessness (OR, 1.37; 95% CI, 1.22-1.55; all P < .001).

“The results of our study underscore the importance of routine, standardized screening for cumulative social disadvantage within VA and community care settings that serve veterans,” Pietrzak said.

He added that findings make it clear that “suicide prevention extends beyond mental health care. Improving the social conditions in which veterans live, work, and age is not only good public policy. It may save lives.”

Mark S. Kaplan, DrPH, a research professor of Social Welfare at the University of California at Los Angeles Luskin School of Public Affairs is familiar with the study findings and said they highlight the need to “approach the question of suicide in much wider terms as opposed to reducing it to psychiatric traits.”

J. John Mann, MD, a professor of translational neuroscience in psychiatry and radiology who studies suicide at Columbia University, New York City, said the study’s findings illustrate that clinicians must do more to understand the lives of patients outside the examination room. He predicted that more screening for social determinants of health will “enrich the amount of information that the clinician will have and lead to a more comprehensive clinical care plan.”

The US Department of Veterans Affairs supported the study. Pietrzak has no disclosures. Other study authors report various disclosures.

Veterans experiencing unstable housing, financial strain, and with poor access to health care have a higher risk of suicidal thoughts and behaviors, according to findings in a new study, leading researchers to call for additional screening to identify those in jeopardy. 

Each incremental increase in social disadvantage was tied to increases in the likelihood of recent suicidal thoughts (odds ratio [OR], 2.14), future suicidal intent (OR, 2.21), and lifetime suicide attempt (OR, 1.78) in a weighted analysis. The self-reported data was published as a cross-sectional study by Pietrzak et al in the December 2025 issue of JAMA Psychiatry.

Veterans whose social plights ranked in the worst 5% were > 20 times more likely to report suicidal thoughts and behaviors than those in the top 5%. Especially striking were the magnitudes of the associations and their persistence after adjustment for psychiatric conditions and other suicide risk factors, lead author Robert H. Pietrzak, PhD, MPH said in an interview with Federal Practitioner.

“This finding highlights how extreme cumulative disadvantage can be overwhelming,” Pietrzak said. “It suggests that suicide risk among veterans increases dramatically when multiple social stressors cluster together. Rather than any single hardship driving risk, it is the cumulative impact of social disadvantage that appears most strongly linked to elevated suicide risk.”

As Pietrzak explained, veterans account for < 7% of total US adults but about 14% of suicide deaths. “Several factors may contribute to this difference, including higher exposure to trauma, elevated rates of psychiatric conditions, challenges with reintegration into civilian life, and structural barriers to care,” Pietrzak said. “Increasingly, social and economic stressors are also recognized by experts and researchers as critical contributors to suicide risk.”

Social determinants of health (SDOH) such as unemployment and lack of access to health care have also been linked to suicide risk, he said.

“Less well understood is how multiple adverse social conditions interact and accumulate to compound suicide risk,” Pietrzak said.

The new study sought to determine the impact of SDOH as a whole, not just in isolation. The study analyzed SDOH in 5 areas—education access and quality, economic conditions, health care access and quality, neighborhood and built environment, and social and community context—via the National Health and Resilience in Veterans Study, which surveyed 4069 veterans. The participants had weighted demographics of mean age 62.2 years; 90.2% were male; and 78.1% White, 11.2% Black, 6.6% Hispanic, 4.2% other.

Past-year suicidal ideation was most highly linked to psychosocial difficulties (OR, 1.58; 95% CI, 1.43-1.75). Future suicidal intent was most highly linked to residing in a mobile home, recreational vehicle, or van (OR, 1.60; 95% CI, 1.24-2.07) in addition to psychosocial difficulties (OR, 1.45; 95% CI, 1.18-1.80). Lifetime suicidal attempt was most highly linked to history of homelessness (OR, 1.37; 95% CI, 1.22-1.55; all P < .001).

“The results of our study underscore the importance of routine, standardized screening for cumulative social disadvantage within VA and community care settings that serve veterans,” Pietrzak said.

He added that findings make it clear that “suicide prevention extends beyond mental health care. Improving the social conditions in which veterans live, work, and age is not only good public policy. It may save lives.”

Mark S. Kaplan, DrPH, a research professor of Social Welfare at the University of California at Los Angeles Luskin School of Public Affairs is familiar with the study findings and said they highlight the need to “approach the question of suicide in much wider terms as opposed to reducing it to psychiatric traits.”

J. John Mann, MD, a professor of translational neuroscience in psychiatry and radiology who studies suicide at Columbia University, New York City, said the study’s findings illustrate that clinicians must do more to understand the lives of patients outside the examination room. He predicted that more screening for social determinants of health will “enrich the amount of information that the clinician will have and lead to a more comprehensive clinical care plan.”

The US Department of Veterans Affairs supported the study. Pietrzak has no disclosures. Other study authors report various disclosures.

Veterans with posttraumatic stress disorder (PTSD) were much more likely than their counterparts to be a perpetrator or victim of violence and suffer from social, legal, and financial problems, a new retrospective analysis finds.

An analysis of 62,298 matched veterans found that those newly diagnosed with PTSD were more likely to be linked to violence (adjusted odds ratio [aOR], 3.98), social problems (aOR, 2.87) legal problems (aOR, 1.75), and financial problems (aOR, 2.01), reported Ouyang et al in the November 2025 issue of the Journal of Affective Disorders.

A separate analysis of 11,758 propensity-matched veterans found that those with PTSD were more likely to experience violence (50.15% vs 11.26%), social problems (64.44% vs 25.32%), legal problems (24.84% vs 8.07%), and financial problems (48.60% vs 19.21%). 

The study does not prove that PTSD is directly linked to these problems. However, Ouyang told Federal Practitioner that the findings suggest "PTSD extends beyond psychiatric symptoms: It significantly impacts economic stability, housing security, and legal safety."

Clinicians should screen for various problems in patients with PTSD, Ouyang said, “particularly given that the risk is highest during the first year.” The study also sought to better understand the effects of PTSD over time.

“While it is established that PTSD creates serious challenges regarding employment, family dynamics, and substance use, most previous studies provided only a cross-sectional snapshot,” Ouyang said. “We aimed to understand the progression over a 10-year period.”

In addition, “previous studies relied heavily on standard diagnosis codes and missed a significant amount of unstructured data,” she said. The new study uses natural language processing, an artificial intelligence field that parses the words people use, to gain insight from clinical notes.

In the cross-sectional analysis of 62,298 veterans, including 31,149 diagnosed with PTSD in the 2011-2012 fiscal year and 31,149 without PTSD (average age 60, 91.49% male, 71.50% White and 19.27% Black), PTSD was linked to higher rates of housing instability (aOR, 1.65), barriers to care (aOR, 1.45), transitions of care (aOR, 1.58), food insecurity (aOR, 1.37), and nonspecific psychosocial needs (aOR, 1.31).

Why might PTSD be linked to violence, which was defined as perpetrated by or against the veteran?

“The primary theory centers on hyperarousal, a symptom of PTSD characterized by a state of constant high alert and anxiety,” Ouyang said. “This state creates difficulties in emotional regulation and impulse control, which can lead to aggressive reactions.”

Patients are also at risk of revictimization, Ouyang added, “where the erosion of social support networks leaves veterans more vulnerable to harm from others.”

Aspects of PTSD are also thought to contribute to problems other than violence, Ouyang said. For example, mental health struggles can make it hard to keep a job and stay financially stable “and veterans may be hesitant to seek help due to stigma until the situation becomes critical, potentially leading to housing loss.”

In terms of solutions, “clinical treatment alone is insufficient,” she said. “We recommend an integrated health care model that combines mental health treatment with referrals to social work and economic support services to address the broader determinants of well-being.”

Brian Klassen, PhD, an associate professor with the Department of Psychiatry and Behavioral Sciences at Rush University Medical Center, reviewed the study for Federal Practitioner. 

The research “underscores how problematic the diagnosis of PTSD is for folks,” said Klassen, the director of Strategic Partnership for the Road Home Program/Center for Veterans and Their Families. “It plays out in lives in trouble with relationships, work, and housing, things like that.”

How PTSD cultivates a veteran’s everyday life is important for clinicians to understand, he said. “A lot of our treatments directly target symptoms: how to help people sleep better, manage their mood. This encourages practitioners to look at the whole person,” Klassen said. “What other kind of resource needs might this person have that are related to—or maybe caused by—their PTSD diagnosis?”

These resources can “include things like job training and housing and financial assistance, maybe help to get out in the community and form relationships with people.”

The US Department of Veterans Affairs and National Institutes of Health funded the study. The study authors and Klassen have no disclosures. 

Veterans with posttraumatic stress disorder (PTSD) were much more likely than their counterparts to be a perpetrator or victim of violence and suffer from social, legal, and financial problems, a new retrospective analysis finds.

An analysis of 62,298 matched veterans found that those newly diagnosed with PTSD were more likely to be linked to violence (adjusted odds ratio [aOR], 3.98), social problems (aOR, 2.87) legal problems (aOR, 1.75), and financial problems (aOR, 2.01), reported Ouyang et al in the November 2025 issue of the Journal of Affective Disorders.

A separate analysis of 11,758 propensity-matched veterans found that those with PTSD were more likely to experience violence (50.15% vs 11.26%), social problems (64.44% vs 25.32%), legal problems (24.84% vs 8.07%), and financial problems (48.60% vs 19.21%). 

The study does not prove that PTSD is directly linked to these problems. However, Ouyang told Federal Practitioner that the findings suggest "PTSD extends beyond psychiatric symptoms: It significantly impacts economic stability, housing security, and legal safety."

Clinicians should screen for various problems in patients with PTSD, Ouyang said, “particularly given that the risk is highest during the first year.” The study also sought to better understand the effects of PTSD over time.

“While it is established that PTSD creates serious challenges regarding employment, family dynamics, and substance use, most previous studies provided only a cross-sectional snapshot,” Ouyang said. “We aimed to understand the progression over a 10-year period.”

In addition, “previous studies relied heavily on standard diagnosis codes and missed a significant amount of unstructured data,” she said. The new study uses natural language processing, an artificial intelligence field that parses the words people use, to gain insight from clinical notes.

In the cross-sectional analysis of 62,298 veterans, including 31,149 diagnosed with PTSD in the 2011-2012 fiscal year and 31,149 without PTSD (average age 60, 91.49% male, 71.50% White and 19.27% Black), PTSD was linked to higher rates of housing instability (aOR, 1.65), barriers to care (aOR, 1.45), transitions of care (aOR, 1.58), food insecurity (aOR, 1.37), and nonspecific psychosocial needs (aOR, 1.31).

Why might PTSD be linked to violence, which was defined as perpetrated by or against the veteran?

“The primary theory centers on hyperarousal, a symptom of PTSD characterized by a state of constant high alert and anxiety,” Ouyang said. “This state creates difficulties in emotional regulation and impulse control, which can lead to aggressive reactions.”

Patients are also at risk of revictimization, Ouyang added, “where the erosion of social support networks leaves veterans more vulnerable to harm from others.”

Aspects of PTSD are also thought to contribute to problems other than violence, Ouyang said. For example, mental health struggles can make it hard to keep a job and stay financially stable “and veterans may be hesitant to seek help due to stigma until the situation becomes critical, potentially leading to housing loss.”

In terms of solutions, “clinical treatment alone is insufficient,” she said. “We recommend an integrated health care model that combines mental health treatment with referrals to social work and economic support services to address the broader determinants of well-being.”

Brian Klassen, PhD, an associate professor with the Department of Psychiatry and Behavioral Sciences at Rush University Medical Center, reviewed the study for Federal Practitioner. 

The research “underscores how problematic the diagnosis of PTSD is for folks,” said Klassen, the director of Strategic Partnership for the Road Home Program/Center for Veterans and Their Families. “It plays out in lives in trouble with relationships, work, and housing, things like that.”

How PTSD cultivates a veteran’s everyday life is important for clinicians to understand, he said. “A lot of our treatments directly target symptoms: how to help people sleep better, manage their mood. This encourages practitioners to look at the whole person,” Klassen said. “What other kind of resource needs might this person have that are related to—or maybe caused by—their PTSD diagnosis?”

These resources can “include things like job training and housing and financial assistance, maybe help to get out in the community and form relationships with people.”

The US Department of Veterans Affairs and National Institutes of Health funded the study. The study authors and Klassen have no disclosures. 

Veterans with posttraumatic stress disorder (PTSD) were much more likely than their counterparts to be a perpetrator or victim of violence and suffer from social, legal, and financial problems, a new retrospective analysis finds.

An analysis of 62,298 matched veterans found that those newly diagnosed with PTSD were more likely to be linked to violence (adjusted odds ratio [aOR], 3.98), social problems (aOR, 2.87) legal problems (aOR, 1.75), and financial problems (aOR, 2.01), reported Ouyang et al in the November 2025 issue of the Journal of Affective Disorders.

A separate analysis of 11,758 propensity-matched veterans found that those with PTSD were more likely to experience violence (50.15% vs 11.26%), social problems (64.44% vs 25.32%), legal problems (24.84% vs 8.07%), and financial problems (48.60% vs 19.21%). 

The study does not prove that PTSD is directly linked to these problems. However, Ouyang told Federal Practitioner that the findings suggest "PTSD extends beyond psychiatric symptoms: It significantly impacts economic stability, housing security, and legal safety."

Clinicians should screen for various problems in patients with PTSD, Ouyang said, “particularly given that the risk is highest during the first year.” The study also sought to better understand the effects of PTSD over time.

“While it is established that PTSD creates serious challenges regarding employment, family dynamics, and substance use, most previous studies provided only a cross-sectional snapshot,” Ouyang said. “We aimed to understand the progression over a 10-year period.”

In addition, “previous studies relied heavily on standard diagnosis codes and missed a significant amount of unstructured data,” she said. The new study uses natural language processing, an artificial intelligence field that parses the words people use, to gain insight from clinical notes.

In the cross-sectional analysis of 62,298 veterans, including 31,149 diagnosed with PTSD in the 2011-2012 fiscal year and 31,149 without PTSD (average age 60, 91.49% male, 71.50% White and 19.27% Black), PTSD was linked to higher rates of housing instability (aOR, 1.65), barriers to care (aOR, 1.45), transitions of care (aOR, 1.58), food insecurity (aOR, 1.37), and nonspecific psychosocial needs (aOR, 1.31).

Why might PTSD be linked to violence, which was defined as perpetrated by or against the veteran?

“The primary theory centers on hyperarousal, a symptom of PTSD characterized by a state of constant high alert and anxiety,” Ouyang said. “This state creates difficulties in emotional regulation and impulse control, which can lead to aggressive reactions.”

Patients are also at risk of revictimization, Ouyang added, “where the erosion of social support networks leaves veterans more vulnerable to harm from others.”

Aspects of PTSD are also thought to contribute to problems other than violence, Ouyang said. For example, mental health struggles can make it hard to keep a job and stay financially stable “and veterans may be hesitant to seek help due to stigma until the situation becomes critical, potentially leading to housing loss.”

In terms of solutions, “clinical treatment alone is insufficient,” she said. “We recommend an integrated health care model that combines mental health treatment with referrals to social work and economic support services to address the broader determinants of well-being.”

Brian Klassen, PhD, an associate professor with the Department of Psychiatry and Behavioral Sciences at Rush University Medical Center, reviewed the study for Federal Practitioner. 

The research “underscores how problematic the diagnosis of PTSD is for folks,” said Klassen, the director of Strategic Partnership for the Road Home Program/Center for Veterans and Their Families. “It plays out in lives in trouble with relationships, work, and housing, things like that.”

How PTSD cultivates a veteran’s everyday life is important for clinicians to understand, he said. “A lot of our treatments directly target symptoms: how to help people sleep better, manage their mood. This encourages practitioners to look at the whole person,” Klassen said. “What other kind of resource needs might this person have that are related to—or maybe caused by—their PTSD diagnosis?”

These resources can “include things like job training and housing and financial assistance, maybe help to get out in the community and form relationships with people.”

The US Department of Veterans Affairs and National Institutes of Health funded the study. The study authors and Klassen have no disclosures. 

TOPLINE:

The use of services for mental health involving video chats with medical professionals increased in female veterans from 2019 to 2022, with women living in urban areas more likely to use the services than their rural counterparts. Black and Hispanic women showed the largest increases.

METHODOLOGY:

• Researchers analyzed trends in video telemental health utilization among female veterans within an observational cohort of Veterans Health Administration (VHA) mental health outpatient visits, by rurality and race, from 2019 to 2022.
• The study included 470,863 female veterans (mean age, 43 years; 51% White individuals) who had ≥ 1 outpatient mental health visit; a subsample of 141,349 veterans with mental health visits in both 2019 and 2022 was analyzed for changes in telemental health use.
• Video telemental health encounters were identified using specific codes for synchronous, video-based mental health care and included both visits at clinics and those at home through the VA Video Connect system.
• The researchers categorized race into 5 groups and classified veterans’ residences as rural and urban using commuting area codes.

TAKEAWAY:

• The use of synchronous video telemental health services among female veterans increased from < 7% to 32% from 2019 to 2022, with stable in-person care rates.
• In 2019, female veterans living in rural areas had an increased likelihood of using video telemental health. However, by 2022, this difference decreased, and female veterans living in urban areas showed equivalent or higher usage. Female veterans living in urban areas had a greater increase in the number of visits in 2022 than their peers living in rural areas.
• Black and Hispanic female veterans showed greater increases in video tele-mental health usage in both urban and rural areas. No significant change in telemental health visits was noted for American Indian and Alaska Native female veterans between 2019 and 2022.
• In the analysis of the subsample, female veterans living in urban areas were 21-35 times more likely to use video telemental health in 2022 vs 2019, whereas female veterans living in rural areas were 7-11 times more likely.

IN PRACTICE:

“The rapid changes observed in SVT-MH [synchronous video telehealth for mental health] use over a relatively short time period underscore the potential for achieving equity through intentional system-level efforts. However, our findings also highlight the risk of overgeneralizing telehealth utilization patterns,” the authors wrote. “Our findings underscore the need for targeted digital care strategies — especially for rural and AIAN [American Indian and Alaska Native] women veterans — to ensure that all veterans benefit equally from virtual care options,” they added.

SOURCE:

This study was led by Michelle A. Mengeling, PhD, MS, of the VHA Office of Rural Health at the Veterans Rural Health Resource Center in Iowa City, Iowa. It was published online on December 10, 2025, in The Journal of Rural Health.

LIMITATIONS:

Female veterans older than 60 years were excluded to avoid confounding with Medicare service usage. Rurality was classified as urban or rural, which may overlook variations in highly rural or isolated areas. The focus on VHA-delivered mental health care might not fully capture the use of video-based telemental health services.

DISCLOSURES:

This study was supported by grants from the US Department of Veterans Affairs, VHA, Office of Rural Health, Veterans Rural Health Resource Center - Iowa City. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this story first appeared on Medscape.com.

TOPLINE:

The use of services for mental health involving video chats with medical professionals increased in female veterans from 2019 to 2022, with women living in urban areas more likely to use the services than their rural counterparts. Black and Hispanic women showed the largest increases.

METHODOLOGY:

• Researchers analyzed trends in video telemental health utilization among female veterans within an observational cohort of Veterans Health Administration (VHA) mental health outpatient visits, by rurality and race, from 2019 to 2022.
• The study included 470,863 female veterans (mean age, 43 years; 51% White individuals) who had ≥ 1 outpatient mental health visit; a subsample of 141,349 veterans with mental health visits in both 2019 and 2022 was analyzed for changes in telemental health use.
• Video telemental health encounters were identified using specific codes for synchronous, video-based mental health care and included both visits at clinics and those at home through the VA Video Connect system.
• The researchers categorized race into 5 groups and classified veterans’ residences as rural and urban using commuting area codes.

TAKEAWAY:

• The use of synchronous video telemental health services among female veterans increased from < 7% to 32% from 2019 to 2022, with stable in-person care rates.
• In 2019, female veterans living in rural areas had an increased likelihood of using video telemental health. However, by 2022, this difference decreased, and female veterans living in urban areas showed equivalent or higher usage. Female veterans living in urban areas had a greater increase in the number of visits in 2022 than their peers living in rural areas.
• Black and Hispanic female veterans showed greater increases in video tele-mental health usage in both urban and rural areas. No significant change in telemental health visits was noted for American Indian and Alaska Native female veterans between 2019 and 2022.
• In the analysis of the subsample, female veterans living in urban areas were 21-35 times more likely to use video telemental health in 2022 vs 2019, whereas female veterans living in rural areas were 7-11 times more likely.

IN PRACTICE:

“The rapid changes observed in SVT-MH [synchronous video telehealth for mental health] use over a relatively short time period underscore the potential for achieving equity through intentional system-level efforts. However, our findings also highlight the risk of overgeneralizing telehealth utilization patterns,” the authors wrote. “Our findings underscore the need for targeted digital care strategies — especially for rural and AIAN [American Indian and Alaska Native] women veterans — to ensure that all veterans benefit equally from virtual care options,” they added.

SOURCE:

This study was led by Michelle A. Mengeling, PhD, MS, of the VHA Office of Rural Health at the Veterans Rural Health Resource Center in Iowa City, Iowa. It was published online on December 10, 2025, in The Journal of Rural Health.

LIMITATIONS:

Female veterans older than 60 years were excluded to avoid confounding with Medicare service usage. Rurality was classified as urban or rural, which may overlook variations in highly rural or isolated areas. The focus on VHA-delivered mental health care might not fully capture the use of video-based telemental health services.

DISCLOSURES:

This study was supported by grants from the US Department of Veterans Affairs, VHA, Office of Rural Health, Veterans Rural Health Resource Center - Iowa City. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this story first appeared on Medscape.com.

TOPLINE:

The use of services for mental health involving video chats with medical professionals increased in female veterans from 2019 to 2022, with women living in urban areas more likely to use the services than their rural counterparts. Black and Hispanic women showed the largest increases.

METHODOLOGY:

• Researchers analyzed trends in video telemental health utilization among female veterans within an observational cohort of Veterans Health Administration (VHA) mental health outpatient visits, by rurality and race, from 2019 to 2022.
• The study included 470,863 female veterans (mean age, 43 years; 51% White individuals) who had ≥ 1 outpatient mental health visit; a subsample of 141,349 veterans with mental health visits in both 2019 and 2022 was analyzed for changes in telemental health use.
• Video telemental health encounters were identified using specific codes for synchronous, video-based mental health care and included both visits at clinics and those at home through the VA Video Connect system.
• The researchers categorized race into 5 groups and classified veterans’ residences as rural and urban using commuting area codes.

TAKEAWAY:

• The use of synchronous video telemental health services among female veterans increased from < 7% to 32% from 2019 to 2022, with stable in-person care rates.
• In 2019, female veterans living in rural areas had an increased likelihood of using video telemental health. However, by 2022, this difference decreased, and female veterans living in urban areas showed equivalent or higher usage. Female veterans living in urban areas had a greater increase in the number of visits in 2022 than their peers living in rural areas.
• Black and Hispanic female veterans showed greater increases in video tele-mental health usage in both urban and rural areas. No significant change in telemental health visits was noted for American Indian and Alaska Native female veterans between 2019 and 2022.
• In the analysis of the subsample, female veterans living in urban areas were 21-35 times more likely to use video telemental health in 2022 vs 2019, whereas female veterans living in rural areas were 7-11 times more likely.

IN PRACTICE:

“The rapid changes observed in SVT-MH [synchronous video telehealth for mental health] use over a relatively short time period underscore the potential for achieving equity through intentional system-level efforts. However, our findings also highlight the risk of overgeneralizing telehealth utilization patterns,” the authors wrote. “Our findings underscore the need for targeted digital care strategies — especially for rural and AIAN [American Indian and Alaska Native] women veterans — to ensure that all veterans benefit equally from virtual care options,” they added.

SOURCE:

This study was led by Michelle A. Mengeling, PhD, MS, of the VHA Office of Rural Health at the Veterans Rural Health Resource Center in Iowa City, Iowa. It was published online on December 10, 2025, in The Journal of Rural Health.

LIMITATIONS:

Female veterans older than 60 years were excluded to avoid confounding with Medicare service usage. Rurality was classified as urban or rural, which may overlook variations in highly rural or isolated areas. The focus on VHA-delivered mental health care might not fully capture the use of video-based telemental health services.

DISCLOSURES:

This study was supported by grants from the US Department of Veterans Affairs, VHA, Office of Rural Health, Veterans Rural Health Resource Center - Iowa City. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this story first appeared on Medscape.com.

The more than 2 million women US veterans are the fastest-growing military population. While research into women veterans has traditionally lagged, more recently studies have begun to focus on their needs impacts of combat and service on women. These studies have found that women veterans preferred tailored solutions focused on women veterans.

A November 2025 study is one of the first to examine the impact of combat on women veterans. It found that those in combat roles had higher levels of depression, posttraumatic stress disorder (PTSD), dissociation, and overall poorer health compared with civilians and noncombat women military personnel. Previous research had found that women veterans had higher rates of lifetime and past-year PTSD (13.4%) compared with female civilians (8.0%), male veterans (7.7%), and male civilians (3.4%). A 2020 US Department of Veterans (VA) study of 4,928,638 men and 448,455 women similarly found that women had nearly twice the rates of depression and anxiety compared with men.

For many veterans, mental health issues may develop or be exacerbated in their return to civilian life. That transition can be especially confusing and isolating for women veterans, according to a 2024 study: “They neither fit in the military due to gendered relations centered on masculinity, or civilian life where they are largely misunderstood as ‘veterans.’ This ‘no woman’s land’ is poorly understood.” Few programs for transitioning veterans have been found effective for women veterans because they’ve been developed for a largely male veteran population. That includes mental health support programs.

Some women may prefer women-only groups, and even that choice may be dependent on their background, service history, socioeconomic level, and other factors. They may feel more comfortable in women-only groups if they’ve experienced MST. Others who have served in combat may choose mixed-gender programs. One study found that some women benefited from being in a mixed-gender group because it enabled them to work on difficulties with men in a safe environment. Other research has found that women veterans with substance use disorders are reluctant to seek help alongside men in the same facilities. 

Accessing care may be especially challenging for rural women veterans. However, separate facilities and women-only groups are not always available, particularly in rural areas where there may be very few women veterans. And even if they are available, rural women are often up against barriers that urban women do not face, such as having to travel long distances to get care. Clinicians also may be hard to find in rural areas. Some participants in a 2025 study were hampered not only by a lack of female practitioners, but practitioners who were well trained to understand and treat the unique needs of female veterans: “[It’s] incredibly difficult to find a mental health practitioner that understands a veteran’s unique experience as a woman,” a participant said.

The more than 2 million women US veterans are the fastest-growing military population. While research into women veterans has traditionally lagged, more recently studies have begun to focus on their needs impacts of combat and service on women. These studies have found that women veterans preferred tailored solutions focused on women veterans.

A November 2025 study is one of the first to examine the impact of combat on women veterans. It found that those in combat roles had higher levels of depression, posttraumatic stress disorder (PTSD), dissociation, and overall poorer health compared with civilians and noncombat women military personnel. Previous research had found that women veterans had higher rates of lifetime and past-year PTSD (13.4%) compared with female civilians (8.0%), male veterans (7.7%), and male civilians (3.4%). A 2020 US Department of Veterans (VA) study of 4,928,638 men and 448,455 women similarly found that women had nearly twice the rates of depression and anxiety compared with men.

For many veterans, mental health issues may develop or be exacerbated in their return to civilian life. That transition can be especially confusing and isolating for women veterans, according to a 2024 study: “They neither fit in the military due to gendered relations centered on masculinity, or civilian life where they are largely misunderstood as ‘veterans.’ This ‘no woman’s land’ is poorly understood.” Few programs for transitioning veterans have been found effective for women veterans because they’ve been developed for a largely male veteran population. That includes mental health support programs.

Some women may prefer women-only groups, and even that choice may be dependent on their background, service history, socioeconomic level, and other factors. They may feel more comfortable in women-only groups if they’ve experienced MST. Others who have served in combat may choose mixed-gender programs. One study found that some women benefited from being in a mixed-gender group because it enabled them to work on difficulties with men in a safe environment. Other research has found that women veterans with substance use disorders are reluctant to seek help alongside men in the same facilities. 

Accessing care may be especially challenging for rural women veterans. However, separate facilities and women-only groups are not always available, particularly in rural areas where there may be very few women veterans. And even if they are available, rural women are often up against barriers that urban women do not face, such as having to travel long distances to get care. Clinicians also may be hard to find in rural areas. Some participants in a 2025 study were hampered not only by a lack of female practitioners, but practitioners who were well trained to understand and treat the unique needs of female veterans: “[It’s] incredibly difficult to find a mental health practitioner that understands a veteran’s unique experience as a woman,” a participant said.

The more than 2 million women US veterans are the fastest-growing military population. While research into women veterans has traditionally lagged, more recently studies have begun to focus on their needs impacts of combat and service on women. These studies have found that women veterans preferred tailored solutions focused on women veterans.

A November 2025 study is one of the first to examine the impact of combat on women veterans. It found that those in combat roles had higher levels of depression, posttraumatic stress disorder (PTSD), dissociation, and overall poorer health compared with civilians and noncombat women military personnel. Previous research had found that women veterans had higher rates of lifetime and past-year PTSD (13.4%) compared with female civilians (8.0%), male veterans (7.7%), and male civilians (3.4%). A 2020 US Department of Veterans (VA) study of 4,928,638 men and 448,455 women similarly found that women had nearly twice the rates of depression and anxiety compared with men.

For many veterans, mental health issues may develop or be exacerbated in their return to civilian life. That transition can be especially confusing and isolating for women veterans, according to a 2024 study: “They neither fit in the military due to gendered relations centered on masculinity, or civilian life where they are largely misunderstood as ‘veterans.’ This ‘no woman’s land’ is poorly understood.” Few programs for transitioning veterans have been found effective for women veterans because they’ve been developed for a largely male veteran population. That includes mental health support programs.

Some women may prefer women-only groups, and even that choice may be dependent on their background, service history, socioeconomic level, and other factors. They may feel more comfortable in women-only groups if they’ve experienced MST. Others who have served in combat may choose mixed-gender programs. One study found that some women benefited from being in a mixed-gender group because it enabled them to work on difficulties with men in a safe environment. Other research has found that women veterans with substance use disorders are reluctant to seek help alongside men in the same facilities. 

Accessing care may be especially challenging for rural women veterans. However, separate facilities and women-only groups are not always available, particularly in rural areas where there may be very few women veterans. And even if they are available, rural women are often up against barriers that urban women do not face, such as having to travel long distances to get care. Clinicians also may be hard to find in rural areas. Some participants in a 2025 study were hampered not only by a lack of female practitioners, but practitioners who were well trained to understand and treat the unique needs of female veterans: “[It’s] incredibly difficult to find a mental health practitioner that understands a veteran’s unique experience as a woman,” a participant said.

TOPLINE:

Message-based psychotherapy (MBP), which uses asynchronous emails or texts, showed effectiveness comparable with that of video-based psychotherapy (VBP) for the treatment of depression on a commercial digital mental health platform, a new study showed.

METHODOLOGY:

• Investigators conducted a pragmatic sequential multiple-assignment randomized clinical trial from 2022 to 2024 involving 850 adult patients with a diagnosis of depression (mean age, 34 years; 66% women; 60% White, 22% Black and 14% Hispanic).
• Patients were initially randomly assigned to receive weekly MBP (n = 423) or VBP (n = 427), with nonresponders randomly assigned at week 6 to receive combination therapy of MBP plus weekly or monthly VBP. All patients received treatment for up to 12 weeks.
• Primary outcomes included depression severity measured by the 9-item Patient Health Questionnaire (PHQ-9), social functioning measured by the Quality of Life in Neurological Disorders 8-item tool, response to treatment (≥ 50% reduction in PHQ-9 total score or Clinical Global Impressions-Improvement score ≤ 2), and remissions (PHQ-9 score < 5).
• Secondary outcomes were treating disengagement, therapeutic alliance measured on the Working Alliance Inventory-Short Revised, quality of care in the past 4 weeks, and treatment satisfaction.

TAKEAWAY:

• Rates of response (47.5% and 47.2%, respectively) and remission (31.4% and 30.3%, respectively) were not significantly different at week 12 between the MBP and VBP groups or for nonresponders rerandomized to either group.
• There were also no significant differences in depression change scores between the MBP and VBP groups or for nonresponders rerandomized to either group.
• Treatment disengagement by week 5 was significantly higher in the VBP vs MBP group (21.3% vs 13.2%; P = .003); VBP responders had stronger initial therapeutic alliance at week 4 than MBP responders (P < .001).
• No significant differences were observed in the quality of care among those who responded only after the second randomization to MBP or VBP.

IN PRACTICE:

"Findings reinforced MBP as viable alternative to VBP. Broader insurance reimbursement for MBP could improve access to evidence-based care," the investigators wrote.

SOURCE:

The study was led by Michael D. Pullmann, PhD, School of Medicine, University of Washington, Seattle. It was published online on October 30 in JAMA Network Open.

LIMITATIONS:

The absence of a waiting list or a no-treatment control group made it difficult to rule out regression to the mean as an explanation for improvements. Additionally, missing data may have affected the robustness of some findings.

DISCLOSURES:

The research was funded by the National Institute of Mental Health. Several investigators reported having financial ties with various sources. Details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Message-based psychotherapy (MBP), which uses asynchronous emails or texts, showed effectiveness comparable with that of video-based psychotherapy (VBP) for the treatment of depression on a commercial digital mental health platform, a new study showed.

METHODOLOGY:

• Investigators conducted a pragmatic sequential multiple-assignment randomized clinical trial from 2022 to 2024 involving 850 adult patients with a diagnosis of depression (mean age, 34 years; 66% women; 60% White, 22% Black and 14% Hispanic).
• Patients were initially randomly assigned to receive weekly MBP (n = 423) or VBP (n = 427), with nonresponders randomly assigned at week 6 to receive combination therapy of MBP plus weekly or monthly VBP. All patients received treatment for up to 12 weeks.
• Primary outcomes included depression severity measured by the 9-item Patient Health Questionnaire (PHQ-9), social functioning measured by the Quality of Life in Neurological Disorders 8-item tool, response to treatment (≥ 50% reduction in PHQ-9 total score or Clinical Global Impressions-Improvement score ≤ 2), and remissions (PHQ-9 score < 5).
• Secondary outcomes were treating disengagement, therapeutic alliance measured on the Working Alliance Inventory-Short Revised, quality of care in the past 4 weeks, and treatment satisfaction.

TAKEAWAY:

• Rates of response (47.5% and 47.2%, respectively) and remission (31.4% and 30.3%, respectively) were not significantly different at week 12 between the MBP and VBP groups or for nonresponders rerandomized to either group.
• There were also no significant differences in depression change scores between the MBP and VBP groups or for nonresponders rerandomized to either group.
• Treatment disengagement by week 5 was significantly higher in the VBP vs MBP group (21.3% vs 13.2%; P = .003); VBP responders had stronger initial therapeutic alliance at week 4 than MBP responders (P < .001).
• No significant differences were observed in the quality of care among those who responded only after the second randomization to MBP or VBP.

IN PRACTICE:

"Findings reinforced MBP as viable alternative to VBP. Broader insurance reimbursement for MBP could improve access to evidence-based care," the investigators wrote.

SOURCE:

The study was led by Michael D. Pullmann, PhD, School of Medicine, University of Washington, Seattle. It was published online on October 30 in JAMA Network Open.

LIMITATIONS:

The absence of a waiting list or a no-treatment control group made it difficult to rule out regression to the mean as an explanation for improvements. Additionally, missing data may have affected the robustness of some findings.

DISCLOSURES:

The research was funded by the National Institute of Mental Health. Several investigators reported having financial ties with various sources. Details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Message-based psychotherapy (MBP), which uses asynchronous emails or texts, showed effectiveness comparable with that of video-based psychotherapy (VBP) for the treatment of depression on a commercial digital mental health platform, a new study showed.

METHODOLOGY:

• Investigators conducted a pragmatic sequential multiple-assignment randomized clinical trial from 2022 to 2024 involving 850 adult patients with a diagnosis of depression (mean age, 34 years; 66% women; 60% White, 22% Black and 14% Hispanic).
• Patients were initially randomly assigned to receive weekly MBP (n = 423) or VBP (n = 427), with nonresponders randomly assigned at week 6 to receive combination therapy of MBP plus weekly or monthly VBP. All patients received treatment for up to 12 weeks.
• Primary outcomes included depression severity measured by the 9-item Patient Health Questionnaire (PHQ-9), social functioning measured by the Quality of Life in Neurological Disorders 8-item tool, response to treatment (≥ 50% reduction in PHQ-9 total score or Clinical Global Impressions-Improvement score ≤ 2), and remissions (PHQ-9 score < 5).
• Secondary outcomes were treating disengagement, therapeutic alliance measured on the Working Alliance Inventory-Short Revised, quality of care in the past 4 weeks, and treatment satisfaction.

TAKEAWAY:

• Rates of response (47.5% and 47.2%, respectively) and remission (31.4% and 30.3%, respectively) were not significantly different at week 12 between the MBP and VBP groups or for nonresponders rerandomized to either group.
• There were also no significant differences in depression change scores between the MBP and VBP groups or for nonresponders rerandomized to either group.
• Treatment disengagement by week 5 was significantly higher in the VBP vs MBP group (21.3% vs 13.2%; P = .003); VBP responders had stronger initial therapeutic alliance at week 4 than MBP responders (P < .001).
• No significant differences were observed in the quality of care among those who responded only after the second randomization to MBP or VBP.

IN PRACTICE:

"Findings reinforced MBP as viable alternative to VBP. Broader insurance reimbursement for MBP could improve access to evidence-based care," the investigators wrote.

SOURCE:

The study was led by Michael D. Pullmann, PhD, School of Medicine, University of Washington, Seattle. It was published online on October 30 in JAMA Network Open.

LIMITATIONS:

The absence of a waiting list or a no-treatment control group made it difficult to rule out regression to the mean as an explanation for improvements. Additionally, missing data may have affected the robustness of some findings.

DISCLOSURES:

The research was funded by the National Institute of Mental Health. Several investigators reported having financial ties with various sources. Details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE: The Veterans Health Administration implemented 18 regional Clinical Resource Hubs (CRHs), where remote clinicians deliver virtual mental health care, addressing staffing gaps amid increasing demand and workforce shortages. Early implementation showed promise in improving access, with program benefits extending beyond temporary staffing solutions.

METHODOLOGY:

• Semistructured interviews were conducted with 36 CRH mental health leaders across all 18 regions.

• A rapid qualitative approach was used, incorporating templated summaries and matrix analysis.

• Participants included leads responsible for implementation and coordination, as well as Chief Mental Health Officers overseeing facility-based services.

• Regional leaders collaborated through executive meetings to ensure appropriate mental health practitioner assignments and effective service delivery to facilities in need.

TAKEAWAY:

• The CRH program demonstrated 3 key values: enhanced integration compared with community care, expanded specialty mental health services in rural areas, and improved provider recruitment and satisfaction.

• Leaders argued that the program could prevent unnecessary delays for veterans who might experience longer wait times for mental health services in the community.

• Mental health practitioners can work virtually across multiple health care systems, with hybrid schedules combining on-site and virtual care delivery.

• The program attracted numerous qualified applicants for virtual care.

IN PRACTICE: “Mental health leaders’ perspectives on CRH value suggest the program is more than a contingency staffing solution for mental health care access challenges, but also potentially offers additional benefits that could be leveraged to improve mental health care services more generally," wrote the authors of the study.

SOURCE: The study was led by the Center for the Study of Healthcare Innovation in Los Angeles. It was published online in Administration and Policy in Mental Health and Mental Health Services Research.

LIMITATIONS: The researchers identified lower productivity among CRH staff compared with facility staff, indicating unused capacity. The program's rapid national implementation may have contributed to challenges, as hubs were established quickly, potentially before fully determining regional demand. Some facilities requiring services may have lacked the necessary infrastructure for timely implementation.

 DISCLOSURES: This work received support from the Veterans Health Administration Primary Care Analytics Team, funded by the Veterans Health Administration Office of Primary Care. The views expressed do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. Government.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: The Veterans Health Administration implemented 18 regional Clinical Resource Hubs (CRHs), where remote clinicians deliver virtual mental health care, addressing staffing gaps amid increasing demand and workforce shortages. Early implementation showed promise in improving access, with program benefits extending beyond temporary staffing solutions.

METHODOLOGY:

• Semistructured interviews were conducted with 36 CRH mental health leaders across all 18 regions.

• A rapid qualitative approach was used, incorporating templated summaries and matrix analysis.

• Participants included leads responsible for implementation and coordination, as well as Chief Mental Health Officers overseeing facility-based services.

• Regional leaders collaborated through executive meetings to ensure appropriate mental health practitioner assignments and effective service delivery to facilities in need.

TAKEAWAY:

• The CRH program demonstrated 3 key values: enhanced integration compared with community care, expanded specialty mental health services in rural areas, and improved provider recruitment and satisfaction.

• Leaders argued that the program could prevent unnecessary delays for veterans who might experience longer wait times for mental health services in the community.

• Mental health practitioners can work virtually across multiple health care systems, with hybrid schedules combining on-site and virtual care delivery.

• The program attracted numerous qualified applicants for virtual care.

IN PRACTICE: “Mental health leaders’ perspectives on CRH value suggest the program is more than a contingency staffing solution for mental health care access challenges, but also potentially offers additional benefits that could be leveraged to improve mental health care services more generally," wrote the authors of the study.

SOURCE: The study was led by the Center for the Study of Healthcare Innovation in Los Angeles. It was published online in Administration and Policy in Mental Health and Mental Health Services Research.

LIMITATIONS: The researchers identified lower productivity among CRH staff compared with facility staff, indicating unused capacity. The program's rapid national implementation may have contributed to challenges, as hubs were established quickly, potentially before fully determining regional demand. Some facilities requiring services may have lacked the necessary infrastructure for timely implementation.

 DISCLOSURES: This work received support from the Veterans Health Administration Primary Care Analytics Team, funded by the Veterans Health Administration Office of Primary Care. The views expressed do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. Government.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: The Veterans Health Administration implemented 18 regional Clinical Resource Hubs (CRHs), where remote clinicians deliver virtual mental health care, addressing staffing gaps amid increasing demand and workforce shortages. Early implementation showed promise in improving access, with program benefits extending beyond temporary staffing solutions.

METHODOLOGY:

• Semistructured interviews were conducted with 36 CRH mental health leaders across all 18 regions.

• A rapid qualitative approach was used, incorporating templated summaries and matrix analysis.

• Participants included leads responsible for implementation and coordination, as well as Chief Mental Health Officers overseeing facility-based services.

• Regional leaders collaborated through executive meetings to ensure appropriate mental health practitioner assignments and effective service delivery to facilities in need.

TAKEAWAY:

• The CRH program demonstrated 3 key values: enhanced integration compared with community care, expanded specialty mental health services in rural areas, and improved provider recruitment and satisfaction.

• Leaders argued that the program could prevent unnecessary delays for veterans who might experience longer wait times for mental health services in the community.

• Mental health practitioners can work virtually across multiple health care systems, with hybrid schedules combining on-site and virtual care delivery.

• The program attracted numerous qualified applicants for virtual care.

IN PRACTICE: “Mental health leaders’ perspectives on CRH value suggest the program is more than a contingency staffing solution for mental health care access challenges, but also potentially offers additional benefits that could be leveraged to improve mental health care services more generally," wrote the authors of the study.

SOURCE: The study was led by the Center for the Study of Healthcare Innovation in Los Angeles. It was published online in Administration and Policy in Mental Health and Mental Health Services Research.

LIMITATIONS: The researchers identified lower productivity among CRH staff compared with facility staff, indicating unused capacity. The program's rapid national implementation may have contributed to challenges, as hubs were established quickly, potentially before fully determining regional demand. Some facilities requiring services may have lacked the necessary infrastructure for timely implementation.

 DISCLOSURES: This work received support from the Veterans Health Administration Primary Care Analytics Team, funded by the Veterans Health Administration Office of Primary Care. The views expressed do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. Government.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.