Veteran suicide prevention in the USA: Evaluating strategies and outcomes within Face the Fight

Abstract: Veteran suicide remains a critical public health crisis in the United States, with rates nearly twice those of the general population. Addressing this challenge requires multiple evidence-based interventions across settings. This paper presents a system dynamics model developed within the Face the Fight (TM) veteran suicide prevention initiative to evaluate and optimize strategies from 2022 to 2032. The model integrates peer-reviewed evidence on intervention effectiveness, subject-matter expert calibration, and annual updates from Veterans Affairs and grantee data to estimate the potential population-level impact of suicide prevention. The model organizes veterans by levels of suicide distress and estimates the impact of interventions in an initial three target areas aligned with a public health approach to suicide prevention: creating protective environments (e.g., secure firearm storage), strengthening access and delivery of suicide care (e.g., suicide-specific clinical programs), and identifying and supporting people at risk (e.g., suicide screening). Model results indicate that focusing solely on high-distress veterans is insufficient to reduce suicide rates to those of the general population, while balanced portfolios combining clinical, community, and firearm-safety approaches yield the greatest projected benefit. Sensitivity analyses demonstrate the model's responsiveness to population distress distributions and intervention capacities, underscoring the need for a balanced, scalable strategy. Evaluating suicide-prevention impact is inherently challenging, but the model provides a dynamic and transparent framework for assessing investment effectiveness, refining strategies, and forecasting long-term outcomes. Its adaptability ensures ongoing insights to guide funding priorities, informs data-driven policy, and extends to other populations and public health challenges where multiple interventions interact to influence outcomes.