Kentucky Veteran and nonveteran suicide 2010–2019: A feasible solution algorithm test of perfect storm theory

Abstract: Veteran suicide remains a pressing public health problem in Kentucky (KY) and the United States. Perfect storm theory (PST) suggests that human behavior arises from the intensity of interactions between instigating, impelling, and disinhibiting forces and could be used to study the effects of interacting factors related to catastrophic behaviors such as self-directed violence. Suicide data were obtained from the KY Violent Death Reporting System for 2010–2019. Subgroups of veteran (n = 1,203, 17.8%) and nonveteran (n = 5,559, 82.2%) decedents were categorized by suicide characteristics, and Feasible Solution Algorithm was used to test the main proposition of PST. KY male veterans differed from nonveteran decedents in that they were significantly more likely to have been White, older, married, educated beyond high school, used a firearm, left a note, lived in a rural area, and had physical health problems. A three-way interaction, χ²(1) = 5.01, p = .0252, supported the main proposition of PST for veterans who were rural and older, in the presence of one or more of the following disinhibiting factors: alcohol found at the scene, recent death/suicide of a friend or family member, traumatic anniversary, blood alcohol content ≥.08, or a positive drug test. The identified interactions contribute to a better understanding of the complex nature of suicide and confirm that PST could be used to guide further research on the antecedents of veteran suicide and its prevention. Our tests of perfect storm theory uncovered important differences in factors related to suicide for older rural veterans. Findings highlight the utility of perfect storm theory, the use of a comprehensive statistical technique, and the need to tailor suicide prevention and intervention efforts to meet older rural veterans’ unique needs.