Suicide among Falkland war veterans

Healthy workers or less healthy leavers? Mortality in military veterans

BACKGROUND

The 'healthy worker effect' predicts that longer employment is positively associated with reduced mortality, but few studies have examined mortality in military veterans irrespective of exposure to conflict.

AIMS

To examine mortality in a large national cohort of Scottish veterans by length of service.

METHODS

Retrospective cohort study comparing survival in up to 30-year follow-up among 57 000 veterans and 173 000 people with no record of service, matched for age, sex and area of residence, who were born between 1945 and 1985. We compared antecedent diagnoses in the two groups to provide information on probable risk factors.

RESULTS

By the end of follow-up, 3520 (6%) veterans had died, compared with 10 947 (6%) non-veterans. Cox proportional hazard analysis confirmed no significant difference overall unadjusted or after adjusting for deprivation. On subgroup analysis, those who left prematurely (early service leavers) were at significantly increased risk of death (hazard ratio (HR) 1.16, 95% confidence interval (CI) 1.09-1.24, P < 0.001), although the increase became non-significant after adjusting for socioeconomic status (HR 1.05, 95% CI 0.99-1.12). Longer-serving veterans were at significantly lower risk of death than non-veterans; the risk decreased both with length of service and in more recent birth cohorts. Smoking-related disease was the greatest contributor to increased mortality in early leavers.

CONCLUSIONS

Among longer-serving veterans, there was evidence of a HWE partly attributable to selective attrition of early service leavers, but birth cohort analysis suggests improvements over time which may also reflect a causal effect of improved in-service health promotion.

Non-fatal self-harm in Scottish military veterans: a retrospective cohort study of 57,000 veterans and 173,000 matched non-veterans

PURPOSE

Although suicide risk in veterans has been widely studied, there is little information on the risk of non-fatal self-harm in this population. We used data from the Scottish Veterans Health Study to conduct an epidemiological analysis of self-harm in veterans, in comparison with people who have never served.

METHODS

We conducted a retrospective, 30-year cohort study of 56,205 veterans born 1945-1985, and 172,741 people with no record of military service, and used Cox proportional hazard models to examine the association between veteran status and cumulative risk of non-fatal self-harm, overall and stratified by birth cohort, sex and length of service. We also examined mental and physical comorbidities, and association of suicide with prior self-harm.

RESULTS

There were 1620 (2.90%) first episodes of self-harm in veterans, compared with 4212 (2.45%) in non-veterans. The difference was statistically significant overall (unadjusted HR 1.27, 95% CI 1.21-1.35, p < 0.001). The risk was highest in the oldest veterans, and in the early service leavers who failed to complete initial training (unadjusted HR 1.69, 95% CI 1.50-1.91, p < 0.001). The risk reduced with longer service and in the intermediate birth cohorts but has increased again in the youngest cohort.

CONCLUSIONS

The highest risk of non-fatal self-harm was in veterans with the shortest service, especially those who did not complete training or minimum engagement, and in the oldest birth cohorts, whilst those who had served the longest were at reduced risk. The risk has increased again in the youngest veterans, and further study of this subgroup is indicated.

Demystifying the "Victimized State": A Civil-Military Crisis in Waiting?

The purpose of this article is to illustrate prescient issues relating to current and ex-military communities in the United Kingdom who have featured heavily within the policy arena over the past decade in relation to several key areas of importance. It will be illustrated how this population becomes visible within the public imagination (via military losses), how discourses relating to the harms they experience are structured and articulated within political and policy domains (particularly in relation to mental health) via “state talk” (qua Sim), and what the potential social consequences are for politically rendering an unproblematized populist view of current and ex-military communities (i.e., pending crises). This argument is made with the express intention of reengaging critical recognition of the distancing of the military institution from the physical and psychological vulnerability of those who have participated in war and military environments. This is an argument returned to pertinence from the recent publication of the Chilcot Inquiry into British involvement in the Iraq war.

What does the literature say about the needs of veterans in the areas of health?

This paper reports on a systematic review undertaken in 2013 aimed at identifying evidence and dismissing some of the myths surrounding the needs of the veteran community. Papers were retrieved from a wide range of sources to ensure that literature covered the key areas of health concerns and focused also on time spent in service. Of the twenty eight papers reviewed categories relating to mental health (including PTSD and suicide), the use of alcohol, trauma, hearing loss, cancer and obesity were identified. Outcomes from the review established that while early service leavers were the most vulnerable there were also aspects within service that had an impact on future life events such as the type of leadership experienced, the cohesion of the unit and facing combat situations. The use of alcohol as a coping mechanism is also considered prevalent with adverse effects as is the worry of family situations at home. The impact of service life on the veteran, especially if suffering trauma will have long lasting psychological and physical outcomes, although it is recognised that veterans in the main have excellent physical and psychological strength and many physical illnesses are not greatly exaggerated from that of the general public.

Argentine psychiatry: report on the 30th Congress

OBJECTIVES

To give a contextualised personal account of the 30th Annual Congress of the Argentine Association of Psychiatrists.

METHODS

Conference attendance and analysis of talks.

RESULTS

The congress demonstrated that Argentine psychiatry is held back by oppressive political regimes and by government underfunding. The drug companies and third-party payers are entering the vacuum.

CONCLUSIONS

Argentine trainees and consultants feel ill-prepared to meet the demands of the biomedical psychiatry.