Suicide After Leaving The UK Armed Forces
A Cohort Study
Leaving any job can be hard but for people leaving the armed forces the adjustment to their new circumstances can sometimes be particularly difficult. For example, ex-military personnel may face obstacles to getting a new job, particularly if they were injured in action. Some become homeless. Others turn to alcohol or drugs or suffer mental illnesses such as depression. These things probably aren’t common but those who leave the armed forces might also be at higher risk of suicide than the general population.
Why Was This Study Done?
Serving members of the UK Armed Forces (the British Army, the Naval Service, and the Royal Air Force) have a lower rate of suicide than the general UK population. The lower rate is probably due to “the healthy worker effect” (i.e., workers tend to be healthier than the general population, since the latter includes people unable to work due to illness or disability). However, there are anecdotal reports that ex-military personnel are more likely to die by suicide than are members of the general population. If these reports are correct, then measures should be put into place to prepare people for leaving the Armed Forces and to provide more support for them once they have left the military. The authors of this new study say that no previous studies had systematically examined suicide risk in individuals leaving the Armed Forces. In this new study, therefore, the psychology researchers examine the suicide rate, timing, and risk factors for suicide in a large group (cohort) of former members of the UK Armed Forces.
What Did the Researchers Do and Find?
The psychology researchers linked data on everyone who left the UK Armed Forces between 1996 and 2005 with information on suicides collected by the National Confidential Inquiry into Suicide and Homicide. Since 1996, the Inquiry has been collecting information about all suicides (defined as cases where the coroner has given a verdict of suicide or of “undetermined death”) in the UK, including information about whether the deceased used mental health services in the year before they died. The aim of the Inquiry is to reduce the risk of suicides (and homicides) in the UK by improving the country’s mental health services. Between 1996 and 2005, 233,803 people left the Armed Forces and 224 (nearly all men) died by suicide. The psychology researchers’ statistical analysis of these data indicates that the overall suicide rate in the ex-military personnel was similar to that in the general population. However, the risk of suicide in men aged 24 y or younger who had left the military was 2–3 times greater than that in the same age group in both the general male population and in men serving in the Armed Forces. The risk of dying by suicide was highest in the first 2 y after leaving the military but remained raised for several years. Risk factors for suicide among ex-military personnel included being male, serving in the Army, having a short length of service, and being of lower rank. Only a fifth of the ex-military personnel who committed suicide had been in contact with mental health services in the year before they died, and the rate of contact with these services was lowest among individuals in the age groups at the highest risk of suicide.
What Do These Research Findings Mean?
These findings indicate that young men leaving the UK Armed Forces are at increased risk of suicide, particularly shortly after leaving. The study was not able to prove the reason for this increased risk, but the authors suggest three main possibilities: (1) the stress of transitioning to civilian life, (2) exposure to adverse experiences while in the military, or (3) a vulnerability to suicide before entering the military. The study provides some evidence to support the third hypothesis—untrained personnel with short lengths of service have a particularly high risk of dying by suicide after leaving the military, suggesting that the increased suicide risk may reflect a pre-military vulnerability. The researchers suggest that practical and psychological preparation might be helpful for people leaving the Armed Forces and that appropriate help-seeking behavior could be encouraged in these individuals. In the UK, the National Health Service is currently piloting a community-based mental health service for military veterans, characterized by regional clinical networks involving partnerships of relevant experts.
Additional Information.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1000026.
This study is further discussed in a PLoS Medicine Perspective by Jitender Sareen and Shay-Lee Belik
The Manchester University Centre for Suicide Prevention provides information about the National Confidential Inquiry into Suicide and Homicide and about other research into suicide, and a list of useful Web sites and help lines for people going through crises
A recent article in the Observer newspaper by Mark Townsend discusses the problems facing UK military personnel when they leave the Armed Forces
Information about suicides among serving members of the UK Armed Forces is published by the Defence Analytical Services Agency
The UK National Health Service provides information about suicide, including statistics about suicide in the UK and links to other resources
MedlinePlus also provides links to further information and advice about suicide
The World Health Organization provides information on the global burden of suicide
Navneet Kapur1*, David While1, Nick Blatchley2, Isabelle Bray2, Kate Harrison2
1 Centre for Suicide Prevention, University of Manchester, Manchester, United Kingdom, 2 Defence Analytical Services and Advice (Ministry of Defence), Bath, United Kingdom
Funding: The Veterans Policy Unit in the UK Ministry of Defence funded this project. They had no role in the design, analysis, interpretation, or decision to submit this paper. We disclosed the paper to the Ministry of Defence prior to submission for publication, and any errors of fact identified by the Ministry were clarified at this time. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness is funded by the National Patient Safety Agency (NPSA).
Competing Interests: NB, IB, KH are employed by Defence Analytical Services and Advice (Ministry of Defence) (formerly Defence Analytical Services Agency). They were not directed by the Ministry of Defence in any way in relation to this paper. The views expressed in this publication are those of the authors and not those of the Ministry of Defence. All other authors declare that they have no conflict of interest.
Academic Editor: Matthew Hotopf, King’s College London, United Kingdom
Citation: Kapur N, While D, Blatchley N, Bray I, Harrison K (2009) Suicide after Leaving the UK Armed Forces —A Cohort Study. PLoS Med 6(3): e1000026 doi:10.1371/journal.pmed.1000026
Copyright: © 2009 Kapur et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Tags: National Confidential Inquiry into Homicide and Suicide, psychology research in suicide, psychology reserach and UK army, Result of exposre to military experiences, suicide and armed forces, suicide rates