DescriptionPurpose: The purpose of this study was to investigate the use of total cholesterol as a biological marker for suicidality in a veteran sample. Rationale: Previous research suggests low total cholesterol may increase the risk of suicidality in susceptible individuals by altering properties of the membranes in the brain. The low cholesterol levels appear to affect serotonin receptor exposure and cause a reduction of serotonin in the brain cells. This alters the reciprocal relationship between the serotonergic and dopaminergic systems and leads to an increase of impulsive, aggressive, self-directed aggressive behaviors, and suicidality in susceptible individuals. Methods: Records of veterans seen at the Coatesville Veterans Affairs Medical Center for suicidality between 2009 to 2015 were reviewed. The variables identified for the study were extracted and analyzed. A total of 188 veteran records were analyzed. Results: The cholesterol levels of veterans reporting suicide ideation or a suicide attempt were significantly lower than the group reporting neither [F(2, 185) = 30.19, p = .000]. There was a significant decrease in cholesterol in veterans who reported suicide ideation or a suicide attempt, when compared to an earlier visit which they were not reporting any such suicidality (t(186) = 7.61, p < 0.05). When attempting to define the characteristics of veterans who reported either suicide ideation or a suicide attempt, it was clear that one group was younger, leaner, had more anxiety, sleep problems, and education than the other group. Conclusions: There is compelling evidence that there may be a link between suicide ideation or a suicide attempt and a change in total cholesterol levels in veterans. More prospective research is needed to assess the reduction in total cholesterol levels to help clinicians identify veterans who are most at risk for suicide ideation or a suicide attempt.