Elsevier

Annals of Epidemiology

Volume 25, Issue 2, February 2015, Pages 96-100
Annals of Epidemiology

Original article
Suicide risk among 1.3 million veterans who were on active duty during the Iraq and Afghanistan wars

https://doi.org/10.1016/j.annepidem.2014.11.020Get rights and content

Abstract

Purpose

We conducted a retrospective cohort mortality study to determine the postservice suicide risk of recent wartime veterans comparing them with the US general population as well as comparing deployed veterans to nondeployed veterans.

Methods

Veterans were identified from the Defense Manpower Data Center records, and deployment to Iraq or Afghanistan war zone was determined from the Contingency Tracking System. Vital status of 317,581 deployed and 964,493 nondeployed veterans was followed from the time of discharge to December 31, 2009. Underlying causes of death were obtained from the National Death Index Plus.

Results

Based on 9353 deaths (deployed, 1650; nondeployed, 7703), of which 1868 were suicide deaths (351; 1517), both veteran cohorts had 24% to 25% lower mortality risk from all causes combined but had 41% to 61% higher risk of suicide relative to the US general population. However, the suicide risk was not associated with a history of deployment to the war zone. After controlling for age, sex, race, marital status, branch of service, and rank, deployed veterans showed a lower risk of suicide compared with nondeployed veterans (hazard ratio, 0.84; 95% confidence interval, 0.75–0.95). Multiple deployments were not associated with the excess suicide risk among deployed veterans (hazard ratio, 1.00; 95% confidence interval, 0.79–1.28).

Conclusions

Veterans exhibit significantly higher suicide risk compared with the US general population. However, deployment to the Iraq or Afghanistan war, by itself, was not associated with the excess suicide risk.

Introduction

The reported increased risk of suicide among recent US military veterans, particularly those who have served in either the Afghanistan or Iraq War, has been of concern among veterans, the public and policy makers. The US Department of the Army reported that the suicide rates in soldiers almost doubled between 2005 and 2009 [1]. Before the Iraq and Afghanistan wars, the suicide rates among active duty and former military personnel had been 20% to 30% lower than that of US general population, adjusting for difference in demographic composition by gender, age, and race [2], [3], [4], [5].

The recent wars in Iraq and Afghanistan are substantially different from prior wars in Vietnam (1965–1973) or the Persian Gulf (1990–1991). Recent war veterans had been deployed repeatedly and for a longer tour than those from previous wars. The types of warfare and injuries sustained by today's troops are also different than those seen in previous wars [6]. Today's military service members are all volunteers, older, and more likely to be married with children. Women make up a greater percentage of service members than their Vietnam-era counterparts as well. Although many postservice health issues of female veterans are likely to mirror those of male veterans, there may be gender specific mental health consequences of military service and battlefield deployment [7].

There have been several studies that compare suicide risk between those who were deployed in Iraq or Afghanistan and those who were not deployed. A few studies reported no higher risk among service members with a history of deployment than others who were not deployed [1], [8], [9], whereas another recent study suggested elevated suicide risk among currently and previously deployed soldiers [10]. Among veteran patients receiving care at U.S. Department of Veterans Affairs (VA) medical facilities, the suicide rate for Iraq and Afghanistan veteran patients was not significantly different than other veteran patients when adjusted for their psychiatric conditions and demographic variables (age, sex, and geographic region) [11].

There has not been a large population-based cohort study that compares post service suicide risk between Iraq and Afghanistan war veterans and contemporary veterans who were not deployed. It has been reported that those who remained in service after deployment are believed to be healthier than those who were discharged [12]. Therefore, a study of postservice suicide risk among veterans would complement a study of military population still on active duty and may elucidate longer term health consequences of wartime service in Iraq and Afghanistan.

Given that many returning veterans screened positive for a mental disorder [13], [14], [15], and that certain mental disorders, especially the presence of major depressive disorder and posttraumatic stress disorder (PTSD), are significant risk factors for suicide and/or suicidal behavior [9], [16], [17], [18], [19]; we attempted to determine whether or not (1) the postservice suicide risk among recent military veterans is similar to that of US population; and whether or not (2) risk of suicide among Iraq and Afghanistan war veterans is similar to that of veteran peers who were not deployed. To this end, we conducted a postservice mortality study of all former active component service members who were discharged from the military service through 2007.

Section snippets

Study participants

Study subjects were identified from 4.1 million individuals who served in the US military from 2001 to 2007. Among these, 1,282,074 served with an active component unit and separated from active duty before the end of 2007. Deployment to Iraq or Afghanistan war theater was determined from the Defense Manpower Data Center Contingency Tracking System records and defined by service location in Iraq, Afghanistan, and surrounding countries or waterways (the Red Sea, the Gulf of Aden, the Gulf of

Characteristics of deployed and nondeployed veteran cohorts

The demographic and military characteristics of the deployed veterans were somewhat different than the nondeployed veteran counterparts. Deployed veterans were slightly younger, included fewer women, fewer nonwhites, and fewer nonmarried. A larger portion of deployed veterans served with the Army and Marine Corps units and conversely, fewer with the Navy (Table 1).

Among the 317,581 deployed veterans, 1650 died through the end of follow-up on December 31, 2009. Of these deaths, 351 were from

Discussion

Many health studies of veterans of two prior war periods, Vietnam era and Gulf War era, showed that the risks of overall mortality and suicide were significantly lower among veterans than those of the US general population irrespective of their place of service [2], [3], [4], [5], [26], [27], [28]. The present study also supports these earlier findings in that mortality risk from all-causes combined was 25% lower in deployed veterans (SMR, 0.75; 95% CI, 0.71–0.79) and 24% lower in nondeployed

Acknowledgments

This research was supported by Grant W81XWH-08-MOMRP-SPCR from the U.S. Army Medical Research and Materiel Command Military Operational Medicine Research Program- Suicide Prevention and Counseling Research. The content of this information does not necessarily reflect the position or the policy of the Government, and no official endorsement should be inferred.

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