Suicide Risk and Precipitating Circumstances Among Young, Middle-Aged, and Older Male Veterans Mark S. Kaplan, DrPH, Bentson H. McFarland, MD, PhD, Nathalie Huguet, PhD, and Marcia Valenstein, MD, MS
As the 11th leading cause of death among Americans of all ages, suicide remains a serious public health problem, and reducing suicide is a national imperative.1,2 The suicide of veterans has become a topic of intense public policy scrutiny in recent years. Until recently, most US studies indicated that both active-duty military personnel3—5 and veterans6 were at a lower risk for suicide than their demographically matched peers.
The increased risk of suicide recently ob- served among veterans of Operations Enduring Freedom and Iraqi Freedom has generated nationwide concern.7,8 The Department of Veterans Affairs (VA) has drawn attention to the rising suicide rate among young veterans and declared the prevention of suicide to be a major priority.9
Lawmakers have also expressed concern about the heightened rate of veterans suicides across the age spectrum.10 For example, the House Committee on Veterans Affairs held a hearing entitled The Truth About Veterans Suicide in May 2008,11 and more recently, the Senate Committee on Veterans Affairs con- ducted a hearing entitled Mental Health Care and Suicide Prevention for Veterans in March 2010.12 In his testimony before the House Committee in May 2008, the Secretary of Veterans Affairs13 presented data showing that male veterans in the community had higher rates of suicide than did other men and that veterans aged 30 to 64 years had the highest rates.
According to the VA Office of the Inspector General, 1000 veterans who receive VA care and as many as 5000 of all veterans die by suicide every year.9 In an analysis of suicide rates among male veterans and nonveterans in Washington state, which has large military bases and a substantial population of veterans, May- nard and Boyko14 found that the 2006 suicide rate was higher among veterans in all age categories. Data from the 2007 Oregon Violent Death Reporting System revealed that the age- adjusted suicide rate was 45.7/100 000 among
male veterans but 27.4/100 000 among non- veteran men.15 McCarthy et al.16 found that male (43/100 000) and female (10/100 000) VA patients had higher suicide rates than did non- veteran men (23/100 000) and women (5/100 000) in the general population, although these increases were likely due, in part, to health problems leading to VA use in addition to veteran status.
In a prospective follow-up study of 320 890 men who participated in the 1986 to 1994 National Health Interview Surveys, Kaplan et al.17 showed that veterans were twice as likely (hazard ratio [HR] = 2.13; 95% confidence in- terval [CI] =1.14, 3.99) to die of suicide as were male nonveterans in the general population. However, not all studies found that veterans were at increased risk for suicide. On the basis of a review of 13 studies of suicide risk among current and former military personnel, Kang and Bullman6 noted that veterans historically had a lower risk of suicide than did the general population. Similarly, Miller et al.18 found no
connection between military service and suicide in a large (but not nationally representative) longitudinal study of middle-aged and elderly men.
The Blue Ribbon Work Group on Suicide Prevention in the Veteran Population19 men- tioned the conflicting evidence regarding the risk of suicide among veterans across age groups. Some evidence suggested that younger vet- erans20 were more vulnerable to suicide than were their older counterparts. In the United Kingdom, Kapur et al.21 found age differences in the rates of suicide and in the prevalence of contact with mental health professionals before death among veterans. They showed that British veterans younger than 24 years were at greater risk for suicide (vs nonveterans) but that fewer had been in contact with mental health pro- fessionals.21 According to a recent analysis of data from Oregon, the rates of suicide for younger veterans have increased since 2005, whereas the rates for older veterans have de- clined.15 The foregoing studies might offer
Objectives. The purpose of this study was to evaluate the risk of suicide among
veteran men relative to nonveteran men by age and to examine the prevalence of
suicide circumstances among male veterans in different age groups (1834, 35
44, 4564, and 65 years). Methods. Data from the National Violent Death Reporting System (20032008)
were used to calculate age-specific suicide rates for veterans (n = 8440) and
nonveterans (n = 21 668) and to calculate the age-stratified mortality ratio for
veterans. Multiple logistic regression was used to compare health status,
stressful life events preceding suicide, and means of death among young,
middle-aged, and older veterans.
Results. Veterans were at higher risk for suicide compared with nonveterans in
all age groups except the oldest. Mental health, substance abuse, and financial
and relationship problems were more common in younger than in older veteran
suicide decedents, whereas health problems were more prevalent in the older
veterans. Most male veterans used firearms for suicide, and nearly all elderly
veterans did so.
Conclusions. Our study highlighted heightened risk of suicide in male veterans
compared with nonveterans. Within the veteran population, suicide might be
influenced by different precipitating factors at various stages of life. (Am J Public
Health. 2012;102:S131S137. doi:10.2105/AJPH.2011.300445)
RESEARCH AND PRACTICE
Supplement 1, 2012, Vol 102, No. S1 | American Journal of Public Health Kaplan et al. | Peer Reviewed | Research and Practice | S131
conflicting evidence regarding the role of age in suicide among veterans because of different sampling methodologies and study designs (e.g., veterans of different eras, only VA health care users, and differe
