Suicide Risk Double Among White Male Veterans

PORTLAND, Ore., June 12 -- As a group, white men who served in the U.S. armed forces are twice as likely to die by their own hands as non-veterans, researchers here found.

The suicide risk was greatest among those with few friends or family who had chronic medical or psychiatric conditions (51% versus 46%, P, reported Mark S. Kaplan, Ph.D., of Portland State University, and colleagues in the July issue of the Journal of Epidemiology and Community Health.

Of note, they said, overweight veterans had a lower suicide rate-30%- than normal-weight veterans (52%), but the difference was not statistically significant.

Although the veterans had a much higher risk of suicide, they were not more likely to die from natural causes or external causes such as accidents or homicides than non-veterans, Dr. Kaplan said.

This is not the first study to link veterans to an increased risk of suicide, but unlike earlier studies that reported data from patients within the Veterans Administration Healthcare System, this study reports findings on veterans treated both inside and outside the system.

The researchers did a prospective follow-up study of 320, 890 adult men included in U.S. National Health Interview Surveys and linked to death certificate information.

Veterans represented 15.7% of the national survey sample but accounted for 31.1% of the suicides, Dr. Kaplan said.

Among the findings:

• Just under 31% of suicides among non-veterans occurred among men ages 45 and older; more than 77% of the suicides among veterans were in that age group (P<0.001).
• Eighty-eight percent of veterans who committed suicide were high school graduates versus 74% of non-veterans (P<0.05).
• Just over half of the veterans who committed suicide had limitations associated with mental or physical illness versus only 23% of non-veterans. (P<0.05).
• Eighty-four percent of veterans killed themselves with a firearm versus 55% of non-veterans (P<0.01).

The authors noted that the study had several limitations including the reliance on death certificate information to obtain suicide data.

Moreover there are no data on suicide attempts, nor was there sufficient information about psychiatric comorbidities. "Therefore, we were unable to examine the role of well-established risk factors such as major depressive disorders or post-traumatic stress disorder," they wrote.

Nonetheless, the authors concluded that the findings have substantial public health implications.

"Clinicians outside the VA system need to be alert for signs of suicidal intent among veterans, as well as their access to firearms," they wrote.

Similarly, they said, healthcare facilities outside the VA system that serve veterans should also recognize the increased risk of suicide in this population. "With the projected risk in functional impairments and psychiatric morbidity among veterans of conflict in Afghanistan and Iraq, clinical and community interventions directed towards patients in both VA and non-VA healthcare facilities are needed," they concluded.