Suicide after leaving the UK Armed Forces 1996-2018: a cohort study

Abstract

Background: There are comparatively few international studies investigating suicide in military veterans and no recent UK studies. We aimed to investigate the rate, timing, and risk factors for suicide in personnel who left the UK Armed Forces (UKAF) over a 22-year period. Methods and findings: We conducted a retrospective cohort study of suicide in personnel who left the regular UKAF between 1996 and 2018 by linking national databases of discharged personnel and suicide deaths. Of the 458,058 individuals who left the UKAF, 1,086 (0.2%) died by suicide. The overall rate of suicide in veterans was not greater than the general population (SMR [95% CI] 94 [88-99]). However, suicide risk was two to four times higher in male and female veterans aged under 25 years than in the same age groups in the general population (age-specific mortality ratios ranging from 160 to 409). Male veterans aged 35 years and older were at reduced risk of suicide (age-specific mortality ratios 47 to 80). Male sex, Army service, discharge between the ages of 16 and 34 years, being untrained on discharge, and length of service under 10 years were associated with increased suicide risk. Factors associated with reduced risk included being married, a higher rank and deployment on combat operations. The rate of contact with specialist NHS mental health services (273/1,086, 25%) was lowest in the youngest age groups (10% for 16-19-year-olds; 23% for 20-24-year-olds). Conclusions: Suicide risk in veterans is not high but there are important differences according to age, with higher risk in young men and women. We found a number of factors which increased the risk of suicide but deployment was associated with reduced risk. Our focus should be on improving and maintaining access to mental health care and social supports for young service leavers, as well as implementing general suicide prevention measures for all veterans.

Sociodemographic inequalities of suicide: a population-based cohort study of adults in England and Wales 2011-2021

“…It is an established finding that suicides are lower in serving members of the armed forces compared to members of the general population [15].It may be due to the "healthy worker effect"; people in employment generally, and especially in physically demanding jobs like the armed forces, are less likely than the general population to be ill or disabled. In the England, recent work has shown that veterans are at no greater risk of suicide than the general population [16]. Our sample will likely capture individuals who since the time of 2011 Census are now veterans, as well as those who remained serving members at the end of study.…”

Risk and Protective Factors for Self-Harm and Suicide Behaviours among Serving and Ex-Serving Personnel of the UK Armed Forces, Canadian Armed Forces, Australian Defence Force and New Zealand Defence Force: A Systematic Review

“…16 The study also reported that ex-serving personnel with a shorter length of service (<10 years of service) were at increased risk. 16 Protective factors for self-harm and suicide behaviours among the military community have been less frequently explored than risk factors, but include social support 18,34–36 , higher educational attainment 37 , employment 38 and holding a more senior rank during service (e.g. officer) 18,19,39 .…”

“…medical discharge). 31,32 Additionally, younger age is a risk factor 16,31,33 , with one recent study from the United Kingdom (UK) reporting that suicide risk was two to three times higher in men and women under 25 years old who had left the UK Armed Forces (compared to the general population). 16 The study also reported that ex-serving personnel with a shorter length of service (<10 years of service) were at increased risk.…”

“…31,32 Additionally, younger age is a risk factor 16,31,33 , with one recent study from the United Kingdom (UK) reporting that suicide risk was two to three times higher in men and women under 25 years old who had left the UK Armed Forces (compared to the general population). 16 The study also reported that ex-serving personnel with a shorter length of service (<10 years of service) were at increased risk. 16 Protective factors for self-harm and suicide behaviours among the military community have been less frequently explored than risk factors, but include social support 18,34–36 , higher educational attainment 37 , employment 38 and holding a more senior rank during service (e.g.…”

Prevalence and risk factors of suicide and suicidal ideation in veterans who served in the British Armed Forces: a systematic review

“…6 Factors that are associated with risk of suicide in veterans include being a young male veteran (under 28 years), discharging as an early service leaver (ESL) (within 4 years of enlistment), being an older (over 40 years) female veteran, or having depression or alcohol problems. [7][8][9] The literature also suggests that veterans who experienced adverse life events before enlisting or who have difficulties adjusting to civilian life may be at higher risk. 10 Currently, there is a scarcity of research on suicide prevalence and risk in veterans within a…”