Young men aged 24 years or less who leave the UK Armed Forces have a two to three times higher risk of suicide than young men in the general population or those still in active service, finds a new study in this week’s PLoS Medicine.
The risk in these men appears to be greatest in the first two years after discharge, in those with a short length of service, and in those of lower rank. The study found a low rate of contact with mental health specialists in the year before death–just 14% for those under 20 years and 20% for those under 24 years.
Nav Kapur (Centre for Suicide Prevention, University of Manchester, UK) and colleagues conducted a cohort study, in which they linked data on everyone who left the UK Armed Forces between 1996 and 2005 with information on suicides collected by the National Confidential Inquiry into Suicide and Homicide. Since 1996, the Inquiry has been collecting information about all suicides in the UK, defined as cases where the coroner has given a verdict of suicide or of ”undetermined death,” including information about whether the deceased used mental health services in the year before they died. During the study period 233,803 individuals left the Armed Forces and 224 died by suicide.
The researchers found that the overall suicide rate in the ex-military personnel was similar to that in the general population. The rate was increased in young men, although their absolute risk of suicide was small (the crude rate of suicide was 29.9 per 100,000 person years in 16-19 year olds, and 34.0 per 100,000 person years in 20-24 year olds).
The study was unable to prove the reason for the increased risk in young men, but the authors suggest three main possibilities: the stress of transitioning to civilian life, exposure to adverse experiences while in the military, or a vulnerability to suicide before entering the military. The study provides some evidence to support the third hypothesis–untrained personnel with short lengths of service were at highest risk of suicide after leaving the military, suggesting that the increased risk may reflect a pre-military vulnerability.
Young people who leave the military could be targeted for suicide prevention strategies, say Kapur and colleagues. These might include, they say, “practical and psychological preparation for discharge and encouraging appropriate help-seeking behaviour once individuals have left the services”.
In an expert commentary on the new study, Jitender Sareen and Shay-Lee Belik (University of Manitoba, Winnipeg, Canada), who were uninvolved in the research, highlight one example of a suicide program that was specifically targeted at an at-risk military population (the US Air Force). They also consider more general public health approaches to suicide prevention.