A new study published in Psychiatric Services suggests greater suicide prevention efforts may need to be put in place for women who join or have completed tours in the military. Compared to civilian women, they’re nearly six times more likely to commit suicide.

The cross-sectional study analyzed data from the 173,969 adult suicides taking place in 23 states between the years 2000 and 2010. The data was collected from the Department of Veterans Affairs, which computed mortality ratios between veterans and non-veterans, as well as gender differences. Of the total number of suicides, over 40,000 were male veterans and over 2,000 were female veterans.

When the results were controlled for both age and gender, the number of veteran suicides was approximately 20 percent higher than expected in 2000; in 2010, they were 60 percent higher. Compared to the 1950s, veterans were eight times more likely to kill themselves. The suicide rate comes out to be 28.7 per 100,000 for women of all ages — and women between the ages 18 and 29 are 12 times more likely to kill themselves than women of any other age group.

"It's staggering," Dr. Matthew Miller, an epidemiologist and suicide expert at Northeastern University not involved with the study, told the Los Angeles Times. "We have to come to grips with why the rates are so obscenely high."

Researchers speculate these rates may be so high because individuals who join the military often have troubled childhoods. A 2014 study published in JAMA Psychiatry found children who experience physical, mental, and/or sexual abuse are at higher risk for depression, drug abuse, and suicidal behavior. This suggests military duty could exacerbate existing suicidal behavior in both veteran men and women.

Regardless, suicide is prevalent for those in the military. In a report for the Congressional Research Service, Erin Bagalman, an analyst in health policy, points out there’s no nationwide surveillance system for suicide among all veterans; this surveillance would better help define the scope of the growing problem, identify the characteristics of higher or lower risk of suicide, as well as track changes among suicide rate and suicide prevention interventions.

Of course, in Bagalman’s proposed public framework for suicide prevention, surveillance is but one step in the right direction. Additional research and development to identify risk and protective factors, plus better, cost-effective access to high quality mental health care all factor into reducing the high rate of suicide.

Source: Hoffmire CA, Kemp JE, and Bossarte RM. Changes in Suicide Mortality for Veterans and Nonveterans by Gender and History of VHA Service Use, 2000–2010, Psychiatric Services. 2015.