Native American people have served in the U.S. military for more than 200 years, historically at high rates relative to their share of the U.S. population.
That legacy of service exists alongside significant health disparities. The Indian Health Service reports that Native adults experience high rates of chronic illnesses, including obesity, asthma and heart disease, and have the highest diabetes rate among U.S. racial groups.
Among veterans, another disparity is particularly stark: suicide.
Among veterans who recently used Veterans Health Administration care, American Indian and Alaska Native veterans had the highest suicide rate among individual racial groups in 2023, at roughly 49 per 100,000, according to the Department of Veterans Affairs. That compared with about 48 per 100,000 among White veterans, 26 among Asian veterans and 17 among Black veterans.
But new VA surveillance data suggest the problem cannot be explained simply by mental illness or geography.
The latest wave of the American Veteran Suicide and Self-Harm Behavior Surveillance Study, or ASCEND, surveyed 15,243 veterans nationwide in 2024. Native veterans were among several racial and ethnic groups reporting a higher prevalence of suicidal thoughts after leaving military service than White veterans.
Across all veterans, 27.7 percent reported experiencing suicidal thoughts after leaving the military, while 14 percent reported suicidal thoughts during the previous year.
Earlier ASCEND findings also showed that Native veterans had a higher lifetime prevalence of suicide attempts than White veterans.
Suicidal thoughts, attempts, and deaths measure different points along the suicide continuum. Looking only at deaths can obscure populations experiencing substantial distress, including people who survive attempts or never attempt suicide.
It can also obscure the conditions that determine whether a veteran receives help before a crisis becomes fatal.
The findings do not mean Native identity itself creates suicide risk. Instead, they raise questions about the conditions surrounding Native veterans’ lives, including use of health caren, geography, economic circumstances, social connection, and whether prevention efforts are designed with input from Native communities.
VA data reveal a potential point of concern about Native veterans’ utilization of benefits and services.
About 30 percent of Native American veterans had a service-connected disability, compared with 23 percent of veterans of other races, according to a VA analysis of 2017 American Community Survey data.
More recent VA data show that 46 percent of AI/AN veterans used at least one VA benefit or service in fiscal year 2023, the lowest utilization rate among the racial and ethnic groups analyzed.
Location matters
Geography presents another contradiction.
Among recent VHA users in 2023, veterans living in rural and highly rural communities had an overall suicide rate of 45 per 100,000, compared with 38.9 among urban veterans. Five-year, race-by-geography data also show a rural disadvantage among AI/AN veterans.
Yet the latest ASCEND survey found that living rurally was not associated with significantly greater prevalence of suicidal thoughts, even though suicide mortality is higher among rural veterans receiving VA care.
That discrepancy suggests that asking who experiences suicidal thoughts and who dies by suicide may produce different answers. Access to care may be part of the explanation.
A 2026 study examining virtual mental-health care for rural Native veterans notes that many live in rural communities and face significant barriers to mental-health services.
A recent VA account of suicide-prevention work with AI/AN veterans reported that more than two-thirds do not use VA mental-health services. Some veterans living on reservations travel three to four hours for care, while limited broadband and computer access can put telehealth out of reach.
Two health systems
Native veterans occupy a distinctive position in the U.S. health care system. Depending on eligibility and location, they may receive care through the VA, Indian Health Service, tribal health programs or urban Indian organizations.
Having multiple potential entry points, however, does not ensure that veterans get care.
Congress requires VA medical centers to designate minority veteran program coordinators who conduct outreach to tribes and urban Indian health organizations, while IHS funds suicide prevention, intervention and postvention programs built around culturally responsive, community-driven approaches.
The challenge is identifying where Native veterans are lost between these systems and how to reach them before suicidal distress becomes a fatal crisis.
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