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Suicide among male veterans: a prospective population-based study

¹ School of Community Health, Portland State University, Portland, Oregon, USA
² Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
³ Institute on Aging, Portland State University, Portland, Oregon, USA

Correspondence to:
Correspondence to:
Dr M S Kaplan
School of Community Health, Portland State University, PO Box 751, Portland, OR 97207-0751, USA;kaplanm{at}pdx.edu

Objectives: To assess the risk of mortality from suicide among male veteran participants in a large population-based health survey.

Design and setting: A prospective follow-up study in the US. Data were obtained from the US National Health Interview Surveys 1986–94 and linked to the Multiple Cause of Death file (1986–97) through the National Death Index.

Participants: The sample comprised 320 890 men, aged 18 years at baseline. The participants were followed up with respect to mortality for 12 years.

Results: Cox proportional hazards analysis showed that veterans who were white, those with 12 years of education and those with activity limitations (after adjusting for medical and psychiatric morbidity) were at a greater risk for completing suicide. Veterans were twice as likely (adjusted hazard ratio 2.04, 95% CI 1.10 to 3.80) to die of suicide compared with non-veterans in the general population. The risk of death from "natural" causes (diseases) and the risk of death from "external" causes did not differ between the veterans and the non-veterans. Interestingly, male veterans who were overweight had a significantly lower risk of completing suicide than those who were of normal weight.

Conclusions: Veterans in the general US population, whether or not they are affiliated with the Department of Veterans Affairs (VA), are at an increased risk of suicide. With a projected rise in the incidence of functional impairment and psychiatric morbidity among veterans of the conflicts in Afghanistan and Iraq, clinical and community interventions that are directed towards patients in both VA and non-VA healthcare facilities are needed.

Abbreviations: BMI, body mass index; HR, hazard ratio; ICD-9, International Classification of Diseases, ninth revision; NHIS, National Health Interview Survey; NHIS-NDI, National Health Interview Survey-National Death Index; VA, Veterans Affairs

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