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Background
New York City is home to nearly one-quarter of the State’s 580,000 veterans. While most veterans return to civilian life without major issues, mental health challenges and suicide persist among some veteran populations. In recent years, a broader definition of “deaths of despair” has emerged; it includes suicide as well as deaths related to alcohol or drug use.¹,²
This analysis presents the most recent rates for New York City veterans’ suicides and deaths of despair from 2012 to 2021, disaggregated by borough, along with key socio-demographic indicators. Mirroring other analyses, the definition of deaths of despair in this report includes International Statistical Classification of Disease and Related Health Problems, 10th Edition (IC-10) codes: alcohol-related diseases (K70, K73-74, X45, Y15); suicide (X60-84, Y87.00); and drug- and alcohol-related poisonings (X-40-44, Y10-14, Y45, 47, 49).
Suggested Citation: Cobbs, E. Coy, D. Ford, MM. Havusha, A. Sandman, D. 2024. “Navigating the Crisis: Deaths of Despair and Suicide Among New York City Veterans” New York Health Foundation. New York, NY. Available at: https://nyhealthfoundation.org/resource/nyc-deaths-of-despair-suicide/.
[1] Commonwealth Fund, “States of Despair: A Closer Look at Rising State Death Rates from Drugs, Alcohol, and Suicide,” https://www.commonwealthfund.org/blog/2018/states-despair-closer-look-rising-state-death-rates-drugs-alcohol-and-suicide, accessed August 2024.
[2] Case, A.; Deaton, A. (2017). Mortality and morbidity in the 21st century. Brookings Papers on Economic Activity. 397-476. doi: 10.1353/eca.2017.0005.
Key Findings
- Veterans in New York City died by suicide at roughly twice the rate of civilians.
- Suicide rates were highest among young veterans (ages 18–34) and white veterans. White veterans in New York City were more than 2.5 times more likely to die by suicide than Black veterans.
- Veterans had a deaths of despair rate 2.5 times higher than that of civilians, with the Bronx showing the highest rates for both groups—nearly double the citywide average.
- Deaths of despair rates were highest among veterans ages 55–64, particularly among Black and Hispanic veterans. In the Bronx, the rate of deaths of despair for veterans ages 55–64 was 10 times higher than for veterans ages 75 and older.
- Suicide rates among veterans reached their highest point in 2017, while deaths of despair peaked in 2016. Although suicide rates dropped after 2017, they increased again in 2021. Similarly, deaths of despair began to rise again in 2020 after declining from their 2016 peak.
Annual Suicide Rate by Veteran Status in New York City, 2012–2021
Veteran suicide rates varied annually and were notably higher than civilian suicide rates. The suicide rates for veterans peaked in 2013 and 2017, with a relative decline afterward. Civilian suicide rates remained stable over the past decade.
Borough Suicide Rate by Veteran Status, 2012–2021
On average, veterans died by suicide at twice the rate of civilians in New York City. The Bronx had the highest borough-specific suicide rate for both veterans and civilians; in the Bronx, veterans had a higher suicide rate than the overall New York State veteran suicide rate.³
[3] New York Health Foundation, “Data Snapshot: Veteran Suicide in New York State (2012–2021)”, https://nyhealthfoundation.org/resource/data-snapshot-veteran-suicide-in-new-york-state-2012-2021/, accessed August 2024.
Borough Suicide Rate by Veteran Status, Disaggregated by Sex, 2012–2021
Both male and female veterans died by suicide at about twice the rate as male and female civilians in New York City. Note: because of low counts, some borough-specific suicide rates for female veterans could not be analyzed.
Borough Suicide Rate by Veteran Status, Disaggregated by Age, 2012–2021
Young veterans (ages 18–34) had the highest suicide rate of all age groups in New York City. The highest suicide rate for any borough-specific age group was among 35–54-year-old veterans in Manhattan.
Borough Suicide Rate by Veteran Status, Disaggregated by Race/Ethnicity, 2012–2021
Suicide rates for veterans had greater variation by race and borough compared to civilians. Overall, white veterans had the highest suicide rates in New York City. However, in the Bronx, Black veterans had higher suicide rates than white veterans.
Annual Deaths of Despair Rates by Veteran Status, 2012–2021
Deaths of despair rates rose for both veteran and civilian populations from 2012 to 2021. Veterans had much higher rates of deaths of despair, peaking in 2016. The highest rate for civilians occurred in 2021.
Borough Deaths of Despair Rates by Veteran Status, 2012–2021
Deaths of despair rates for veterans were 2.5 times higher than the rate for civilians in New York City. The Bronx had a significantly higher rate of deaths of despair compared to other boroughs.
Borough Deaths of Despair by Veteran Status, Disaggregated by Sex, 2012–2021
Rates of deaths of despair for female veterans were more than three times the rate for female civilians in New York City. Rates were twice as high for male veterans as for male civilians. The Bronx had the highest rate of deaths of despair for each group, regardless of veteran status or sex.
Borough Deaths of Despair Rates by Veteran Status, Disaggregated by Age, 2012–2021
Deaths of despair rates were highest for residents ages 55–64, for both civilians and veterans in New York City. Veterans in the Bronx ages 55–64 had notably high rates of deaths of despair.
Borough Deaths of Despair Rates by Veteran Status, Disaggregated by Race/Ethnicity, 2012–2021
Death of despair rates were highest for Black and Hispanic/Latino veterans in New York City, with Black veterans in the Bronx having the highest rates.
Deaths of Despair and Suicide Modality by Veteran Status in New York City, 2012–2021
Veterans were more likely to die by suicide with a firearm, while civilians were much more likely to use other modes. Veteran deaths of despair were more likely to be alcohol-related; civilian deaths of despair were more likely to be drug–related.
Considerations
- Expanded data definitions: Researchers and public health practitioners could consider adopting the expanded “deaths of despair” definition to more accurately capture the full range of premature veteran mortality. This broader definition, which includes deaths by suicide, alcohol, and drugs, reflects key causes of premature mortality among U.S. adults and contributes to the nation’s declining life expectancy. Experts from the U.S. Department of Veterans Affairs have recommended incorporating this definition into clinical services and suicide prevention strategies for veterans.⁴,⁵
- Targeted outreach: When considering the expanded definition of deaths of despair, the understanding of who is most affected shifts significantly in terms of both age and race. This broader perspective is important for prevention efforts because focusing on suicide alone can obscure the full picture, masking which populations are most in need of behavioral health services. The expanded definition, which includes deaths related to substance use, reveals disparities that may not be evident when only suicide data is examined, particularly highlighting the vulnerability of adults ages 55–64 and certain racial and ethnic groups.
- Program response: Health and social service providers should further consider how best to implement the most effective and targeted services to prevent deaths of despair. For example, it is important to examine how existing suicide prevention programs and initiatives do or don’t account for the full spectrum of veterans’ needs to prevent deaths of despair, including the extent to which program models account for substance use and health-related social needs.
[4] Katz, I.R.; Dent, K.R.; Morley, S.W.; Hein, T.C.; Hoff, R.A.; McCarthy, J.F. (2020). ‘Can “deaths of despair” serve as a focus for planning and evaluating clinical and preventive services for Veterans?’ Psychiatry Research. https://doi.org/10.1016/j.psychres.2020.112841.
[5] Office of Suicide Prevention, U.S. Department of Veteran Services (2023). “2023 National Veteran Suicide Prevention Annual Report,” https://www.mentalhealth.va.gov/docs/data-sheets/2023/2023-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-508.pdf
Veterans Treatment Courts Across New York State
As of 2023, there are 35 VTCs operating in New York State. Of the 62 counties in New York, 25 counties operate at least one VTC.
Top Veterans Treatment Courts by Participation
Since 2013, when the first VTC was established, 1,318 veterans have participated. Just three courts—the Buffalo City Court, Suffolk 1st District Court, and Nassau District Court—together account for approximately half of all cases and number of participants (n = 684). These courts were some of the first established VTCs in New York. VTCs established more recently would have fewer cases.
[1] Feuer, Alan; Hong, Nicole; Weiser, Benjamin, and Ransom Jan. “N.Y.’s Legal Limbo: Pandemic Creates Backlog of 39,200 Criminal Cases,” The New York Times, June 22, 2020.
Veterans Treatment Court Completion Rates
The court system measures participants’ completion of the New York State VTC program by tracking “program closures” when a participant’s case is closed in the system. Three-quarters (74.5%) of program closures from 2013 through 2023 were successful, with VTC participants graduating from their program or having adjournment in contemplation of dismissal. Approximately 1 in 10 closures (11.1%) were defined as unsuccessful, meaning the participant failed to complete the program. Another 13.4% of all closures were reported as administrative.
