Suicide risk in military veterans from the Iraq and Afghanistan conflicts


It’s hard not to picture scenes from the great war films when we consider the mental health of veterans. Images from Apocolypse Now, The Deer Hunter, Full Metal Jacket and The Hurt Locker are etched onto the public psyche in such a way that it’s sometimes hard to separate fact from fiction.

Research has shown that military veterans are at risk of various mental health problems and suicide is a major problem in this group.

In the US, the Veterans Health Administration (VHA) provides support for military personnel returning from conflict, including those who served in Iraq and Afghanistan; Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). The VHA seeks to provide tailored services to prevent suicide and reduce mental illness.

A new cohort study published in the Journal of Consulting and Clinical Psychology will help to inform this work, as it looks at the association between military service in Iraq and Afghanistan, psychiatric comorbidity and death from suicide.

The study followed a cohort of nearly 6 million veterans who used the VHA for a 12 month period in 2007-2008. This cohort included over 300,000 OEF/OIF veterans, but was mostly made up of older veterans from earlier conflicts. The average age of the cohort was 60.9 years and 90.5% were male.

The analysis looked at veterans who were not currently on active duty and study participants were assessed for depression, schizophrenia, bipolar disorder, substance use disorder, post-traumatic stress disorder (PTSD) and other anxiety disorders using the VHA’s National Patient Care Database. The main outcome of interest was death by suicide.

Here’s what they found:

  • OEF/OIF veterans were quite different from non-OEF/OIF veterans:
    • They were younger (32.7 vs. 62.5 years)
    • There were more women (12.5% vs 9.4%)
    • They were more likely to be diagnosed with depression, PTSD and other anxiety disorders
  • There were 1,920 deaths from suicide during the 12 month study period:
    • 5% were OEF/OIF veterans
  • The suicide rate was:
    • 38 per 100 000 person-years in OEF/OIF veterans
    • 36 per 100 000 person-years in non-OEF/OIF veterans
  • Amongst those with a mental health diagnosis, the risk of suicide was:
    • HR 4.41 (95% CI 2.57 to 7.55) in OEF/OIF veterans
    • HR 2.48 (95% CI 2.27 to 2.71) in non-OEF/OIF veterans

The authors conclude that:

These findings highlight the importance of mental health screening and intervention for OEF/OIF veterans.

It is perhaps surprising that OEF/OIF veterans with a psychiatric diagnosis are twice as likely to kill themselves as non-OEF/OIF veterans. OEF/OIF veterans are, after all, a self-selecting group compared to the largely conscripted group who make up the non-OEF/OIF veterans. It’s also worth noting that VHA services are not available to many non-OEF/OIF veterans.

One explanation for these findings is that non-OEF/OIF veterans may have already died from suicide prior to the study period (2007-2008). Suicide risk is high soon after the conflict has occurred, so this study may suffer from ‘survivor bias’.

If you need help

If you need help and support now and you live in the UK or the Republic of Ireland, please call the Samaritans on 116 123.

If you live elsewhere, we recommend finding a local Crisis Centre on the IASP website.

We also highly recommend that you visit the Connecting with People: Staying Safe resource.


Ilgen MA, McCarthy JF, Ignacio RV, Bohnert AS, Valenstein M, Blow FC, Katz IR. Psychopathology, Iraq and Afghanistan service, and suicide among Veterans Health Administration patients. J Consult Clin Psychol. 2012 Jun;80(3):323-30. Epub 2012 Apr 30. [PubMed abstract]

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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