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Disclosures: The authors report no relevant financial disclosures.
September 15, 2020
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Military service member suicide rates increase after separation and vary by demographics

Source/Disclosures
Disclosures: The authors report no relevant financial disclosures.
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Suicide rates appeared to increase among United States military service members after transition to civilian life, but the risk varied by demographic characteristics, according to study results published in JAMA Network Open.

“Increased risk [for] suicide has generally been associated with military separation,” Chandru Ravindran, MS, of the Center of Excellence for Suicide Prevention in New York, and colleagues wrote. “In a retrospective cohort study of 3.9 million U.S. military personnel who served during Operation Enduring Freedom or Operation Iraqi Freedom, separation from military service was associated with a substantially higher risk [for] suicide mortality. These findings converged with the results of a separate analysis of service members in the United States and a cohort study of Armed Forces personnel in the United Kingdom.”

Army veteran at clinic
Source: Adobe Stock

Despite findings that suggest the immediate period after discharge may be a vulnerable time for suicide risk, more data are needed to identify which members of the transitioning cohort are at increased risk and when that risk is highest, according to the investigators.

To obtain this needed data, Ravindran and colleagues conducted a retrospective population-based cohort study in which they collected military service and demographic data of 1,868,970 service members who were included in the VA/Department of Defense Identity Repository. Specifically, they included those who served on active duty in the U.S. Air Force, Army, Coast Guard, Marine Corps or Navy after Sept. 11, 2001, and who separated from active status between January 2010 and December 2017. Suicide mortality within 6 years following military service separation served as the main outcome.

Results showed 3,030 suicides, of which 2,860 occurred among men and 170 among women, occurred through the end of the study period and within its measured time frame. The researchers observed statistically significant variance in suicide risk according to demographic and military service characteristics. Suicide rates appeared to generally peak 6 to 12 months following separation and declined only modestly over the study period. Male service members were at statistically significantly higher risk for suicide vs. their female counterparts (HR = 3.13; 95% CI, 2.68-3.69). Those who transitioned at younger ages, such as at 17 to 19 years (HR = 4.46; 95% CI, 3.71-5.36), were at approximately 4.5 times greater risk vs. those who transitioned at an older age, such as at 40 years. Further, risk varied according to service branch, with those who separated from the Marine Corps (HR = 1.55; 95% CI, 1.36-1.78) and the Army (HR = 1.48; 95% CI, 1.31-1.67) at higher risk vs. those who separated from the Air Force. Those who separated from the active component were at higher risk than those who separated from the reserve component (HR = 1.29; 95% CI, 1.18-1.42). Moreover, service members with a shorter service length were at higher risk (HR = 1.26; 95% CI, 1.11-1.42) vs. those with a longer service history.

“National leaders at the highest levels of the U.S. government have been concerned about suicide rates among service members transitioning to civilian life,” Ravindran and colleagues wrote. “We believe this cohort study provides much-needed data to help inform prevention efforts among this veteran cohort.”