Article Text
Abstract
Objectives To compare the risk of death by suicide in male veterans with age-matched civilians.
Design Retrospective cohort study linking provincial administrative databases between 1990 and 2013 with follow-up complete until death or December 31, 2015.
Setting Population-based study in Ontario, Canada.
Participants Ex-serving Canadian Armed Forces and Royal Canadian Mounted Police veterans living in Ontario who registered for provincial health insurance were included. A civilian comparator group was matched 4:1 on age and sex.
Main outcome Death by suicide was classified using standard cause of death diagnosis codes from a provincial registry of mandatory data collected from death certificates. Fine and Gray sub-distribution hazards regression compared the risk of death by suicide between veterans and civilians. Analyses were adjusted for age, residential region, income, rurality and major physical comorbidities.
Results 20 397 male veterans released to Ontario between 1990 and 2013 and 81 559 age–sex matched civilians were included. 4.2% of veterans died during the study time frame, compared with 6.5% of the civilian cohort. Death by suicide was rare in both cohorts, accounting for 4.6% and 3.6% of veteran and civilian deaths, respectively. After adjustment for confounders, veterans had an 18% lower risk of dying from causes other than suicide (HR 0.82, 95% CI 0.76 to 0.89) and a similar risk of dying by suicide (HR 1.01, 95% CI 0.71 to 1.43), compared with civilians.
Conclusions Deaths by suicide were rare in male veterans residing in Ontario. Our findings demonstrate that veterans had a similar risk of suicide-related mortality as an age-matched civilian population. A better understanding of effective suicide prevention as well as clarifying pathways to seeking and receiving mental health supports and services are important areas for future consideration.
- veteran
- military
- mortality
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Footnotes
Contributors AM, AK, MW and PK contributed to the conception and design of the work. AM, MW and PK contributed to the acquisition of data. AM and MW contributed to the analysis of the work. All authors (AM, AK, MW, HT, CH, NTF, PK) contributed to the interpretation of data, drafting and revising the manuscript critically for important intellectual content, approve the final version to be published and agree to be accountable for all aspects of the work.
Funding This study was funded by an unrestricted contribution from True Patriot Love, a philanthropic organisation dedicated to supporting Canadian veterans and their families. This study was partially supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and/or information compiled and provided by the Canadian Institute of Health Information (CIHI).
Competing interests The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. The analyses, conclusions, opinions and statements expressed in the material are those of the author(s), and not necessarily those of CIHI.
Ethics approval This study received ethics approval from the Queen’s University Health Sciences Research Ethics Board.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data set from this study is held securely in coded form at ICES. While data sharing agreements prohibit ICES from making the data set publicly available, access may be granted to those who meet prespecified criteria for confidential access (available at www.ices.on.ca/DAS). The full data set creation plan and underlying analytic code are available from the authors upon request, understanding that the programs may rely upon coding templates or macros that are unique to ICES.
Patient consent for publication Not required.