Suicide among Scottish military veterans: follow-up and trends
Introduction
Of all the health outcomes putatively associated with veteran status, none is more distressing than suicide. Despite extensive research, there remains no consensus as to whether military service, encompassing operational deployment or not, increases the risk of suicide, although the majority of studies support the view that there is no clear evidence of increased risk.1 2 We have previously published the findings of a 31-year retrospective cohort study examining the risk of suicide in a cohort of 57 000 veterans in Scotland between 1981 and 2012, in comparison with 173 000 non-veterans matched for age, sex and area of residence, and found no statistically significant difference between veterans and non-veterans overall, although there was a significantly higher risk in female veterans in comparison with non-veteran women.3 There have been few more recently published studies on the epidemiology of suicide in veterans, an exception being a Swedish study which reported similar risk in deployed and non-deployed veterans.4 The majority of other recent studies have focused on identification of risk factors for suicide, generally with the aim of developing or targeting preventive strategies.5 Nonetheless, monitoring the epidemiology of suicide remains important, in light of the potential impact of these strategies or changes in underlying risk factors.
Our original cohort, which provided data on veterans to the end of 2012, has now been refreshed to provide an additional ten year birth cohort, and updated outcome data to the end of 2017, equating to a further 22 000 veterans and 80 000 non-veterans and an additional 5 years of follow-up of the original subjects. This has enabled us to examine whether there have been any changes over time, and also to look at longer-term trends in the risk of suicide in veterans in comparison with matched non-veterans.
Abstract
Objectives The risk of suicide among UK military veterans remains unclear. Few recent studies have been undertaken, and most studies found no clear evidence of increased risk. We used data from the Trends in Scottish Veterans Health cohort to investigate suicides up to 2017 in order to examine whether there have been any changes in the long-term pattern of veteran suicides since our earlier study to 2012, and to compare trends in the risk of suicide among veterans with matched non-veterans.
Method Retrospective cohort study of 78 000 veterans and 253 000 non-veterans born between 1945 and 1995, matched for age, sex and area of residence, using survival analysis to examine the risk of suicide in veterans in comparison with non-veterans overall and by subgroup, and to investigate associations with specific mental health conditions.
Results Up to 37 years of follow-up, 388 (0.5%) veterans and 1531 (0.6%) non-veterans died from suicide. The risk of suicide among veterans did not differ from non-veterans overall. Increased risk among early service leavers was explained by differences in deprivation, and the previously reported increased risk in female veterans is now confined to older women. Suicide was most common in the fifth decade of life, and around 20 years postservice. A history of mood disorder or post-traumatic stress disorder was non-significantly more common in veterans.
Conclusions Veterans are not at increased risk of suicide overall. The highest risk for both men and women is in middle age, many years after leaving service.
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