Identifying release-related precursors to suicide among Canadian Veterans between 1976 and 2012

LAY SUMMARY The Veteran Suicide Mortality Study describes the risk of death by suicide for Canadian Veterans using data linkage at Statistics Canada. The study includes Veterans released with Regular Force or Reserve Force Class C service over the period 1976-2012. Both male and female Veterans had higher risk of suicide if they released at non-officer ranks. For men, the risk of suicide death peaked around four years after release from the military. For women, the risk of suicide death peaked around 20 years after release. This study provides information for the timing of prevention efforts. Introduction: Veteran suicide is a top public health concern, and researching and preventing suicides is a priority for Veterans Affairs Canada. Over the period 1976 to 2012, Canadian Veterans had a significantly higher risk of suicide than did the Canadian general population. This article examines risk factors at release from the Canadian military to inform suicide prevention efforts. Methods: The Veteran Suicide Mortality Study examined suicide deaths in a cohort of more than 220,000 Canadian Veterans released from the military between 1976 and 2012. Military data from the Department of National Defence were linked to mortality records at Statistics Canada. Cox proportional models, hazard ratios, and hazard function graphs were used to identify risk factors at release and suicide mortality risk by years since release. Results: For men, increased suicide risk was associated with Junior Non-Commissioned Member (NCM) rank, and younger age at release. For male Junior NCMs, the risk of suicide death peaked around four years after release from the military, then decreased to a lower risk that remained stable 10-30 years after release. For women, increased suicide risk was associated with NCM rank, and the suicide risk was lowest in the early years after release and peaked around 20 years after. Discussion: These findings suggest that the risk of suicide varies across subgroups of the Veteran population and extends beyond the first few years after release from the Canadian Armed Forces. These findings provide evidence to ensure prevention and treatment efforts take into account different risk profiles for male and female Veterans.