New government research shows that female military veterans commit suicide at nearly six times the rate of other women, a startling finding that experts say poses disturbing questions about the backgrounds and experiences of women who serve in the armed forces.
Their suicide rate is so high that it approaches that of male veterans, a finding that surprised researchers because men generally are far more likely than women to commit suicide.
"It's staggering," said Dr. Matthew Miller, an epidemiologist and suicide expert at Northeastern University who was not involved in the research. "We have to come to grips with why the rates are so obscenely high."
FOR THE RECORD:
Female veteran suicide: In the June 8 Section A, an article about the high rate of suicide among female veterans said that the Pentagon found that an estimated 10% of active-duty women were raped and another 13% subjected to other unwanted sexual contact. In fact, the 2012 Defense Department survey found that 23% of active-duty women had experienced a sexual assault, but it did not distinguish between rape and other kinds of sexual contact.
Though suicide has become a major issue for the military over the last decade, most research by the Pentagon and the Veterans Affairs Department has focused on men, who account for more than 90% of the nation's 22 million former troops. Little has been known about female veteran suicide.
The rates are highest among young veterans, the VA found in new research compiling 11 years of data. For women ages 18 to 29, veterans kill themselves at nearly 12 times the rate of nonveterans.
In every other age group, including women who served as far back as the 1950s, the veteran rates are between four and eight times higher, indicating that the causes extend far beyond the psychological effects of the recent wars.
The data include all 173,969 adult suicides — men and women, veterans and nonveterans — in 23 states between 2000 and 2010.
It is not clear what is driving the rates. VA researchers and experts who reviewed the data for The Times said there were myriad possibilities, including whether the military had disproportionately drawn women at higher suicide risk and whether sexual assault and other traumatic experiences while serving played a role.
Whatever the causes, the consistency across age groups suggests a long-standing pattern.
"We've been missing something that now we can see," said Michael Schoenbaum, an epidemiologist and military suicide researcher at the National Institute of Mental Health who was not part of the work.
The 2011 death of 24-year-old Katie Lynn Cesena is one of a dozen cases The Times identified in Los Angeles and San Diego counties. Cesena's death highlights two likely factors in the rates.
First, she had reported being raped by a fellow service member. The Pentagon has estimated that 10% of women in the military have been raped while serving and another 13% subject to unwanted sexual contact, a deep-rooted problem that has gained attention in recent years as more victims come forward.
The distress forced Cesena out of the Navy, said her mother, Laurie Reaves.
She said her daughter was being treated for post-traumatic stress disorder and depression at the VA Medical Center in San Diego and lived in fear of her purported rapist — who was never prosecuted — and his friends.
Cesena had started writing a memoir and shared the beginning on Facebook. "I would like to dedicate this book to the United States Navy and all the men and women who have bravely served our country with humility and have been raped and were brave enough to tell someone, whether anything came of it or not," she wrote.
The second factor was Cesena's use of a gun, a method typically preferred by men.
In the general population, women attempt suicide more often than men but succeed less because women usually use pills or other methods that are less lethal than firearms. Female veterans, however, are more likely than other women to have guns, government surveys have shown.
In the new data, VA researchers found that 40% of the female veterans who committed suicide used guns, compared with 34% of other women — enough of a difference to have a small effect on the rates.
Another area of interest to researchers is the backgrounds of women who join the military.
Female service members have always been volunteers, and their elevated suicide rates across all generations may be part of a larger pattern. Male veterans 50 and older — the vast majority of whom served during the draft era, which ended in 1973 — had roughly the same suicide rates as nonveteran men their age. Only younger male veterans, who served in the all-volunteer force, had rates that exceeded those of other men.
The differences suggest that the suicide rates may have more to do with who chooses to join the military than what happens during their service, said Claire Hoffmire, the VA epidemiologist who led the research. A more definitive explanation would require information not included in the data, such as when each veteran served and for how long.
Hoffmire pointed to recent research showing that men and women who join the military are more likely to have endured difficult childhoods, including emotional and sexual abuse.
Other studies have found that Army personnel — before enlistment — had elevated rates of suicidal thinking, attempts and various mental health problems. Those studies did not break out the numbers for women.
Though the U.S. military has long provided camaraderie and a sense of purpose to men, it has been a harsher place for women. "They lack a sense of belonging," said Leisa Meyer, a historian at the College of William and Mary in Virginia and an expert on women in the military.
The Pentagon capped the number of women at 2% of the total military until 1967. Women trained in separate units until the late 1970s. Historically, they were nurses, which in wartime meant exposure to trauma.
In Afghanistan and Iraq, where roadside bombs were common, women suffered unprecedented numbers of casualties. But Defense Department data show their active-duty suicide rate did not rise — a sharp contrast to men, who saw their rate double.
The new data, which cover about half the veteran population, show that suicide rates rise sharply after service members leave the military.
In all, 40,571 men and 2,637 women identified as veterans through military records killed themselves over the 11 years in the data. The overall results were published online last month in the journal Psychiatric Services.
Suicide rates are usually expressed as the annual number of deaths for every 100,000 people. For male veterans, that figure was 32.1, compared with 20.9 for other men.
The numbers were much further apart for women: 28.7 for veterans and 5.2 for everybody else.
A stratification of the data by age group — which was provided to The Times — shows that young veterans face the greatest risk.
Among men 18 to 29 years old, the annual number of suicides per 100,000 people were 83.3 for veterans and 17.6 for nonveterans.
The numbers for women in that age group: 39.6 and 3.4.
The differences between female veterans and other women are less extreme in older age groups but still considered alarmingly high by researchers.
The states in the study represent about half the nation's veterans but did not include California.
In the local cases identified by The Times, one pattern stood out: Several women had been discharged early for psychiatric or medical problems.
A back injury forced out Sara Leatherman in 2009 and continued to cause her pain. She was also suffering from traumatic memories of maiming and death she witnessed as a medic in Iraq, said her grandmother, Virginia Umbaugh.
Leatherman was 24, attending community college in La Mesa in San Diego County and receiving treatment for PTSD when she hanged herself in her grandmother's shower in 2010, Umbaugh said.
The war, however, was not the only factor. Leatherman had tried to kill herself with pills while stationed in Texas, before going to Iraq, said Umbaugh, who raised her. "I don't think there's any one answer," she said.
In other cases, veteran status seemed almost incidental, with decades passing since military service and no clear link to the broken relationships, financial problems, mental health troubles and other disappointments that can accumulate in the course of a life.
Linda Raney was 65 years old in 2011 and dealing with problems that mounted for several years: the death of her sister in a car accident, money and health difficulties.
She was living with an aunt in Acton and was disappointed that she didn't meet the financial requirements for the VA to help her get her own place.
"She didn't want to be a burden on her aunt," said her nephew, Kevin Pearcy. One afternoon, she called him to say goodbye, then committed suicide with prescription pills.
She had never talked much about her time in the Air Force.
"I don't know her specialty," Pearcy said. "She was very young."