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Rodway C, Ibrahim S, Westhead J, Bojanić L, Turnbull P, Appleby L, Bacon A, Dale H, Harrison K, Kapur N. Suicide after leaving the UK Armed Forces 1996-2018: A cohort study. PLoS Med 2023; 20:e1004273. [PMID: 37552686 PMCID: PMC10409259 DOI: 10.1371/journal.pmed.1004273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/06/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND There are comparatively few international studies investigating suicide in military veterans and no recent UK-wide studies. This is important because the wider context of being a UK Armed Forces (UKAF) veteran has changed in recent years following a period of intensive operations. We aimed to investigate the rate, timing, and risk factors for suicide in personnel who left the UKAF over a 23-year period. METHODS AND FINDINGS We carried out a retrospective cohort study of suicide in personnel who left the regular UKAF between 1996 and 2018 linking national databases of discharged personnel and suicide deaths, using survival analysis to examine the risk of suicide in veterans compared to the general population and conditional logistic regression to investigate factors most strongly associated with suicide after discharge. The 458,058 individuals who left the UKAF accumulated over 5,852,100 person years at risk, with a median length of follow-up of 13 years, were mostly male (91%), and had a median age of 26 years at discharge. 1,086 (0.2%) died by suicide. The overall rate of suicide in veterans was slightly lower than the general population (standardised mortality ratio, SMR [95% confidence interval, CI] 94 [88 to 99]). However, suicide risk was 2 to 3 times higher in male and female veterans aged under 25 years than in the same age groups in the general population (age-specific mortality ratios ranging from 160 to 409). Male veterans aged 35 years and older were at reduced risk of suicide (age-specific mortality ratios 47 to 80). Male sex, Army service, discharge between the ages of 16 and 34 years, being untrained on discharge, and length of service under 10 years were associated with higher suicide risk. Factors associated with reduced risk included being married, a higher rank, and deployment on combat operations. The rate of contact with specialist NHS mental health services (273/1,086, 25%) was lowest in the youngest age groups (10% for 16- to 19-year-olds; 23% for 20- to 24-year-olds). Study limitations include the fact that information on veterans was obtained from administrative databases and the role of pre-service vulnerabilities and other factors that may have influenced later suicide risk could not be explored. In addition, information on contact with support services was only available for veterans in contact with specialist NHS mental health services and not for those in contact with other health and social care services. CONCLUSIONS In this study, we found suicide risk in personnel leaving the UKAF was not high but there are important differences according to age, with higher risk in young men and women. We found a number of factors which elevated the risk of suicide but deployment was associated with lower risk. The focus should be on improving and maintaining access to mental health care and social support for young service leavers, as well as implementing general suicide prevention measures for all veterans regardless of age.
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Affiliation(s)
- Cathryn Rodway
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Jodie Westhead
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Lana Bojanić
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Andy Bacon
- Armed Forces Team, NHS England, London, United Kingdom
- Westminster Centre for Research in Veterans, University of Chester, Chester, United Kingdom
| | - Harriet Dale
- Ministry of Defence, Defence Statistics Health, Bristol, United Kingdom
| | - Kate Harrison
- Ministry of Defence, Defence Statistics Health, Bristol, United Kingdom
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Research Centre, University of Manchester, Manchester, United Kingdom
- Mersey Care NHS Foundation Trust, Liverpool, United Kingdom
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Williamson V, Murphy D, Stevelink SAM, Allen S, Jones E, Greenberg N. Delivering treatment to morally injured UK military personnel and Veterans: The clinician experience. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1897495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Victoria Williamson
- King’s Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
| | - Dominic Murphy
- King’s Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
- Research Department, Combat Stress, Leatherhead, UK
| | - Sharon A. M. Stevelink
- King’s Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
| | - Shannon Allen
- King’s Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
| | - Edgar Jones
- King’s Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
| | - Neil Greenberg
- King’s Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
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M. Mark K, Leightley D, Pernet D, Murphy D, Stevelink SA, T. Fear N. Identifying Veterans Using Electronic Health Records in the United Kingdom: A Feasibility Study. Healthcare (Basel) 2019; 8:healthcare8010001. [PMID: 31861575 PMCID: PMC7151350 DOI: 10.3390/healthcare8010001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 01/01/2023] Open
Abstract
There is a lack of quantitative evidence concerning UK (United Kingdom) Armed Forces (AF) veterans who access secondary mental health care services-specialist care often delivered in high intensity therapeutic clinics or hospitals-for their mental health difficulties. The current study aimed to investigate the utility and feasibility of identifying veterans accessing secondary mental health care services using National Health Service (NHS) electronic health records (EHRs) in the UK. Veterans were manually identified using the Clinical Record Interactive Search (CRIS) system-a database holding secondary mental health care EHRs for an NHS Trust in the UK. We systematically and manually searched CRIS for veterans, by applying a military-related key word search strategy to the free-text clinical notes completed by clinicians. Relevant data on veterans' socio-demographic characteristics, mental disorder diagnoses and treatment pathways through care were extracted for analysis. This study showed that it is feasible, although time consuming, to identify veterans through CRIS. Using the military-related key word search strategy identified 1600 potential veteran records. Following manual review, 693 (43.3%) of these records were verified as "probable" veterans and used for analysis. They had a median age of 74 years (interquartile range (IQR): 53-86); the majority were male (90.8%) and lived alone (38.0%). The most common mental diagnoses overall were depressive disorders (22.9%), followed by alcohol use disorders (10.5%). Differences in care pathways were observed between pre and post national service (NS) era veterans. This feasibility study represents a first step in showing that it is possible to identify veterans through free-text clinical notes. It is also the first to compare veterans from pre and post NS era.
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Affiliation(s)
- Katharine M. Mark
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK (D.L.); (D.P.); (D.M.); (N.T.F.)
| | - Daniel Leightley
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK (D.L.); (D.P.); (D.M.); (N.T.F.)
| | - David Pernet
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK (D.L.); (D.P.); (D.M.); (N.T.F.)
| | - Dominic Murphy
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK (D.L.); (D.P.); (D.M.); (N.T.F.)
- Combat Stress, Tyrwhitt House, Oaklawn Road, Leatherhead KT22 0BX, UK
| | - Sharon A.M. Stevelink
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK (D.L.); (D.P.); (D.M.); (N.T.F.)
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London SE5 8AF, UK
- Correspondence: ; Tel.: +44-(0)20-7848-5817
| | - Nicola T. Fear
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK (D.L.); (D.P.); (D.M.); (N.T.F.)
- Academic Department of Military Mental Health, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
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