Why the Modern Veteran’s Risk of Suicide Remains Stuck — and What We’re Ignoring

Every day, veterans confront a question no one wants to ask: Why don’t we know how to stop this yet?

Despite decades of effort, billions of dollars spent, and national attention, the suicide risk among post-9/11 veterans remains alarmingly elevated. Research shows that veterans who served in the Global War on Terror (GWOT) and subsequent campaigns face higher rates of suicidal behavior than many previous generations. One compelling answer lies at the intersection of moral injury, neuropsychiatric harm (linked to deployment logistics such as mandatory prophylactic drugs), and a system built for war, not reintegration.

The Data: Elevated Risk, Limited Progress

According to the Department of Veterans Affairs (VA), recent reports indicate veterans are about 57 % more likely than non-veteran adults to die by suicide. Mental Health VA+2PTSD.va+2 While that figure reflects all veterans, research specifically on “recent campaign” veterans shows that exposure to potentially morally injurious events (PMIEs) is strongly correlated with suicidal ideation (SI), suicide planning (SP), and suicide attempts (SA).

A 2021 study found that among combat veterans, exposure to PMIEs significantly increased odds of SI, SP and SA. PubMed This is not simply a function of combat-exposure or traditional PTSD. Moral injury appears to be an independent risk factor, above and beyond PTSD or depression. PMC

Thus, the problem isn’t just “we’re not doing enough” — it’s “we’re doing the wrong things, or incomplete things.”

Moral Injury: The Invisible Wound

“Moral injury” is a term that’s gained traction in recent years among researchers and clinicians. According to the National Center for PTSD, moral injury refers to the “lasting psychological, biological, spiritual, and social impact of perpetrating, failing to prevent, or witnessing acts that transgress deeply held moral beliefs and expectations.”

Key points:

• Many GWOT-era veterans served in environments where the “enemy” wasn’t always uniform, rules of engagement were ambiguous, and civilian-casualty risk high, creating fertile ground for morally injurious events.

  
  

• Research shows that veterans who endorsed high levels of moral injury (via instruments such as the Moral Injury Events Scale) had higher rates of suicidal ideation and attempts. For example, one study found that veterans with “probable moral injury” had about three times the odds of suicidal ideation and six times the odds of a suicide attempt, even after controlling for PTSD and depression. PMC

  
  

• Clinically, moral injury often involves shame, guilt, and a breakdown of identity (e.g., “I am not the person I thought I was,” “I failed my mission,” “I committed acts I can’t live with”). These are distinct from fear-based trauma (PTSD) and are poorly addressed by standard mental-health protocols. Mental Health VA

  
  

• The association between moral injury and suicide is increasingly recognized: a systematic review (2023) found consistent evidence that higher moral-injury exposure is linked to higher suicidal behaviors in veterans. PubMed

  
  

Moral injury is not just a buzz-term; it’s a critical component of the veteran-suicide equation that remains under-integrated in policy, clinical practice, and the veteran community.

Neuropsychiatric Harm: The Other Overlooked Factor

Another less-discussed piece of the risk puzzle involves deployment-related exposures. One example being the antimalarial drug Mefloquine (brand name Lariam®). (Read CVA's Article on Mefloquine here)This drug was widely issued to troops in certain theaters (including parts of Afghanistan and Iraq) as malaria prophylaxis.Key research findings:

• A 2017 study found that among service members prescribed mefloquine, there was an increased risk of incident anxiety compared to doxycycline recipients (IRR = 1.12). Among non-deployed mefloquine recipients, the risk of PTSD was higher (IRR = 1.83) compared to atovaquone/proguanil recipients. PMC

  
  

• Case studies and clinical reviews show that mefloquine can cause persistent neuropsychiatric adverse events, including insomnia, anxiety, nightmares, mood disturbances, cognitive dysfunction, and in rare cases psychosis or suicide. PMC+2PMC+2

  
  

• According to VA public health guidance, common side effects include nausea, vomiting, dizziness, difficulty sleeping and “bad dreams”; more serious effects may involve seizures, restlessness, confusion and unusual behavior. Public Health VA

  
  

• While some recent veteran-cohort studies found little long-term difference in psychiatric outcomes when comparing exposed vs unexposed veterans (e.g., a 2022 cross-sectional cohort study). PubMed+1 But that literature remains contested, and many veterans advocate that the risk is under-recognized.Thus, for GWOT-era veterans, the risk equation is not just “I served in war” but includes “What did I wear/what did I ingest/who ordered what I had to do in morally unconstrained settings?” Mefloquine may not explain all of the risk, but it is an amplifier in a population already vulnerable to moral injury, repeated deployment strain, and reintegration stress.

  
  

Why These Factors Produce Elevated Suicide Risk

When you combine moral injury + neuropsychiatric harm + reintegration gaps, you get a potent brew of:

• Identity disruption: A veteran may return from service feeling detached from civilian norms, burdened by what they’ve seen or done, and stripped of the mission and structure that gave them purpose.

  
  

• Cognitive/neurochemical dysregulation: If deployed exposures (like mefloquine, blast exposure, sleep deprivation) impair neurocognitive/emotional regulation, the veteran is more vulnerable to mood disorders, impulsivity, and suicidal thinking.

  
  

• Lack of meaningful follow-up: Existing systems often treat the veteran’s return like a routine discharge rather than a potential tipping point. Without a sustained support ecosystem, risk can escalate unnoticed.

  
  

• Systemic misfit: Traditional mental-health modes (PTSD-focused therapy) do not always fully address moral injury or deployment-related neuro-harm. The veteran may feel misunderstood by civilian providers or “othered” by the VA.

  
  

• The combined effect: elevated baseline risk and fewer effective mitigation pathways.

  
  

Implications for Policy and Practice

This layered understanding demands multi-pronged reform, not single-track solutions. Some key implications should be:

1. Screening and assessment protocols must expand beyond PTSD and depression to include moral injury exposure (PMIEs) and neuropsychiatric deployment exposures (e.g., antimalarials, blast history).

   
   

2. Clinical trainings must incorporate moral-injury frameworks by helping providers interpret guilt/shame/spiritual injury as legitimate clinical and existential phenomena.

   
   

3. Deployment-exposure records must be transparent and linked to follow-up care, so veterans who took drugs like mefloquine or were exposed to blast/chemicals have clear pathways for diagnosis, monitoring, and disability evaluation.

   
   

4. Suicide-prevention systems (hotlines, VA programs) must be adapted to the modern veteran cohort. For example, one-call interventions are insufficient; a sustained, multi-touch follow-up model is necessary.

   
   

5. Funding and research should prioritize high-risk sub-populations (recent campaign veterans, multiple deployments, known antimalarial use) and track outcomes over time, not just service-connected status.

   
   

6. Peer-based networks and community integration matter: healing moral injury isn’t just about therapy — it’s about reconnecting veterans to mission, identity, and community.

   
   

Conclusion

We must stop treating veteran suicide as if it were a uniform phenomenon with one size-fits-all solutions. The modern veteran’s reality is complex. It's rooted in multiple deployments, ambiguous missions, neuro-chemical exposures, moral injury, and a reintegration system ill-equipped to address these intersections.

When we accept that moral injury and deployment-related neuropsychiatric harm are not optional or fringe concerns, but central drivers of veteran suicide risk, we unlock the path to more effective reform.

Recognizing that a veteran may have taken mefloquine, or witnessed acts that violated their moral code, or returned home and found no purpose, means we must redesign how we intervene, how we follow up, and how we systematize care.

Because when a veteran calls the crisis line, answers the questions, and hangs up; what matters is what happens after. That next day. That next call. That next text. That next check-in. Until the veteran no longer feels alone.

We owe nothing less.