Abstract
OBJECTIVES: Suicide in recent veterans is an international concern. An association between mental disorders and suicide has been established, but less information is available about an association between physical health problems and suicide among veterans. This study extends this area of inquiry by examining the relationship of both physical and mental health problems with suicidal ideation in a representative national sample of Canadian veterans.
MÉTHODS: Subjects were a stratified random sample of 2,658 veterans who had been released from the Canadian Armed Forces Regular Force during 1998–2007 and had participated in the 2010 Survey on Transition to Civilian Life. Associations between physical and mental health and past-year suicidal ideation were explored in multivariate regression models using three measures of physical and mental health.
RESULTS: The prevalence of suicidal ideation was 5.8% (95% confidence interval [CI]: 5.0%–6.8%). After adjustment for covariates, ideation was associated with gastrointestinal disorders (adjusted odds ratio [AOR] 1.66, CI: 1.03–2.65), depression or anxiety (AOR 5.06, CI: 2.97–8.62) and mood disorders (AOR 2.91, CI: 1.67–5.07); number of physical (AOR 1.22, CI: 1.05–1.42) and mental conditions (AOR 2.32, CI: 2.01–2.68); and SF-12 Health Survey physical health (AOR 0.98, CI: 0.96-0.99 for each 1 point increase) and mental health (AOR 0.88, CI: 0.87–0.89).
CONCLUSIONS: Physical health was independently associated with suicidal ideation after adjustment for mental health status and socio-demographic characteristics. The findings underscore the importance of considering physical health in population-based suicide prevention efforts and in mitigating suicide risk in individual veterans.
Keywords: Veterans, suicidal ideation, physical health, mental health, suicide
Résumé
OBJECTIFS: Les suicides de militaires récemment démobilisés sont un enjeu international. On a établi une association entre les troubles mentaux et le suicide, mais on a moins d’information sur une association possible entre les problèmes de santé physique et le suicide chez les anciens combattants. Nous avons voulu élargir le champ de recherche en examinant la relation entre les troubles de santé physique et mentale et l’idéation suicidaire au sein d’un échantillon national représentatif d’anciens combattants canadiens.
MÉTHODE: Nos sujets étaient un échantillon aléatoire stratifié de 2 658 anciens combattants démobilisés de la force régulière des Forces canadiennes entre 1998 et 2007 et ayant participé à l’Enquête sur la transition à la vie civile de 2010. Nous avons analysé les associations entre la santé physique et mentale et l’idéation suicidaire au cours de l’année antérieure à l’aide de modèles de régression multivariés comportant trois indicateurs de santé physique et mentale.
RÉSULTATS: La prévalence de l’idéation suicidaire était de 5,8 % (intervalle de confiance de 95 % [IC]: 5,0–6,8). Compte tenu des covariables, l’idéation était associée aux troubles gastro-intestinaux (rapport de cotes ajusté [RCA] 1,66, IC: 1,03–2,65), à la dépression ou à l’anxiété (RCA 5,06, IC: 2,97-8,62) et aux troubles de l’humeur (RCA 2,91, IC: 1,67–5,07); au nombre de troubles physiques (RCA 1,22, IC: 1,05–1,42) et mentaux (RCA 2,32, IC: 2,01–2,68); à l’état de santé physique selon le questionnaire de santé SF-12 (RCA 0,98, IC: 0,96–0,99 pour chaque point d’augmentation) et à l’état de santé mentale selon le SF-1 2 (RCA 0,88, IC: 0,87–0,89).
CONCLUSIONS: La santé physique était indépendamment associée à l’idéation suicidaire après élimination des effets de l’état de santé mentale et des caractéristiques sociodémographiques. Ces constatations soulignent l’importance de tenir compte de la santé physique dans les efforts de prévention du suicide axés sur l’ensemble de la population et pour atténuer le risque de suicide chez les anciens combattants sur une base individuelle.
Mots clés: ancien combattant, ideation suicidaire, santé physique, santé mentale, suicide
Footnotes
Source of Funding: Government of Canada.
Conflict of Interest: Drs. Thompson, Zamorski, VanTil and Pedlar and Ms. Sweet and Ms. MacLean are employees of the Government of Canada.
References
- 1.Levy BS, Sidel VW. Health effects of combat: A life-course perspective. Arma Rev Public Health. 2009;30(1):123–36. doi: 10.1146/annurev.publhealth.031308.100147. [DOI] [PubMed] [Google Scholar]
- 2.Nock MK, Deming CA, Fullerton CS, Oilman SE, Goldenberg M, Kessler RC, et al. Suicide among soldiers: A review of psychosocial risk and protective factors. Psychiatry. 2013;76(2):97–125. doi: 10.1521/psyc.2013.76.2.97. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Kang HK, Bullman TA. Is there an epidemic of suicides among current and former U.S. military personnel? Ann Epidemiol. 2009;19(10):757–60. doi: 10.1016/j.annepidem.2009.05.004. [DOI] [PubMed] [Google Scholar]
- 4.Statistics Canada. Canadian Forces Cancer and Mortality Study: Causes of Death. Ottawa, ON: Statistics Canada; 2011. [Google Scholar]
- 5.Belik S, Stein MB, Asmundson GJG, Sareen J. Are Canadian soldiers more likely to have suicidal ideation and suicide attempts than Canadian civilians? Am J Epidemiol. 2010;172(11):1250–58. doi: 10.1093/aje/kwq290. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Fear NT, Ward VR, Harrison K, Davison L, Williamson S, Blatchley NF. Suicide among male regular UK Armed Forces personnel, 1984–2007. Occup Environ Med. 2009;66:438–41. doi: 10.1136/oem.2008.040816. [DOI] [PubMed] [Google Scholar]
- 7.Black SA, Gallaway MS, Bell MR, Ritchie EC. Prevalence and risk factors associated with suicides of army soldiers 2001–2009. Mil Psychol. 2011;23:433–51. [Google Scholar]
- 8.Kapur N, While D, Blatchley N, Bray I, Harrison K. Suicide after leaving the UK armed forces — a cohort study. PLoS Med. 2009;Mar3(63):e26. doi: 10.1371/journal.pmed.1000026. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Griffith J. Suicide and war: The mediating effects of negative mood, posttraumatic stress disorder symptoms, and social support among army National Guard soldiers. Suicide Life Threat Behav. 2012;42(4):453–69. doi: 10.1111/j.1943-278X.2012.00104.x. [DOI] [PubMed] [Google Scholar]
- 10.Kaplan MS, McFarland BH, Huguet N, Newsom JT. Physical illness, functional limitations, and suicide risk: A population-based study. Am J Orthopsych. 2007;77(1):56–60. doi: 10.1037/0002-9432.77.1.56. [DOI] [PubMed] [Google Scholar]
- 11.Zivin K, Kim HM, McCarthy JF, Austin KL, Hoggatt KJ, Walters H, Valenstein M. Suicide mortality among individuals receiving treatment for depression in the Veterans Affairs health system: Associations with patient and treatment setting characteristics. Am J Public Health. 2007;97(12):2193–98. doi: 10.2105/AJPH.2007.115477. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Kaplan MS, McFarland BH, Huguet N, Valenstein M. Suicide risk and precipitating circumstances among young, middle-aged and older male veterans. Am J Public Health. 2012;S1:S131–37. doi: 10.2105/AJPH.2011.300445. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry. 2008;192(2):98–105. doi: 10.1192/bjp.bp.107.040113. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Mansfield AJ, Bender RH, Hourani LL, Larson GE. Suicidal or self-harming ideation in military personnel transitioning to civilian life. Suicide Life Threat Behav. 2011;41(4):392–405. doi: 10.1111/j.1943-278X.2011.00039.x. [DOI] [PubMed] [Google Scholar]
- 15.Ilgen MA, McCarthy JF, Ignacio RV, Bohnert AS, Valenstein M, Blow FC, et al. Psychopathology, Iraq and Afghanistan service, and suicide among Veterans Health Administration patients. J Consult Clin Psychol. 2012;80(3):323–30. doi: 10.1037/a0028266. [DOI] [PubMed] [Google Scholar]
- 16.Bossarte RM, Knox KL, Piegari R, Altieri J, Kemp J, Katz IR. Prevalence and characteristics of suicide ideation and attempts among active military and veteran participants in a national health survey. Am J Public Health. 2012;102(Suppl1):S38–40. doi: 10.2105/AJPH.2011.300487. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Boulos D, Zamorski MA. Deployment-related mental disorders among Canadian Forces personnel deployed in support of the mission in Afghanistan, 2001–2008. CMAJ. 2013;185(11):E545–52. doi: 10.1503/cmaj.122120. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.LeardMann CA, Powell TM, Smith TC, Bell MR, Smith B, Boyko EJ, et al. Risk factors associated with suicide in current and former US military personnel. JAMA. 2013;310(5):496–506. doi: 10.1001/jama.2013.65164. [DOI] [PubMed] [Google Scholar]
- 19.Sareen J, Belik SL, Afifi TO, Asmundson GJ, Cox BJ, Stein MB. Canadian military personnel’s population attributable fractions of mental disorders and mental health service use associated with combat and peacekeeping operations. Am J Public Health. 2008;98(12):2191–98. doi: 10.2105/AJPH.2008.134205. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, et al. Suicide prevention strategies: A systematic review. JAMA. 2005;294(16):2064–74. doi: 10.1001/jama.294.16.2064. [DOI] [PubMed] [Google Scholar]
- 21.Thompson JM, MacLean MB, Van Til L, Sudom K, Sweet J, Poirier A, et al. Survey on Transition to Civilian Life: Report on Regular Force Veterans. Technical Report. Charlottetown, PE: Veterans Affairs Canada, Charlottetown; 2011. [Google Scholar]
- 22.Dominick KL, Golightly YM, Jackson GL. Arthritis prevalence and symptoms among US non-veterans, veterans, and veterans receiving Department of Veterans Affairs healthcare. J Rheumatol. 2006;33(2):348–54. [PubMed] [Google Scholar]
- 23.Ratcliffe GE, Enns MW, Belik SL, Sareen J. Chronic pain conditions and suicidal ideation and suicide attempts: An epidemiologic perspective. Clin J Pain. 2008;24(3):204–10. doi: 10.1097/AJP.0b013e31815ca2a3. [DOI] [PubMed] [Google Scholar]
- 24.Russell D, Turner RJ, Joiner TE. Physical disability and suicidal ideation: A community-based study of risk/protective factors for suicidal thoughts. Suicide Life Threat Behav. 2009;39(4):440–51. doi: 10.1521/suli.2009.39.4.440. [DOI] [PubMed] [Google Scholar]
- 25.Scott KM, Hwang I, Chiu WT, Kessler RC, Sampson NA, Angermeyer M. Chronic physical conditions and their association with first onset of suicidal behavior in the world mental health surveys. Psychosom Med. 2010;72(7):712–19. doi: 10.1097/PSY.0b013e3181e3333d. [DOI] [PubMed] [Google Scholar]
- 26.Kline A, Ciccone DS, Falca-Dodson M, Black CM, Losonczy M. Suicidal ideation among National Guard troops deployed to Iraq: The association with postdeployment readjustment problems. J Nerv Ment Dis. 2011;199(12):914–20. doi: 10.1097/NMD.0b013e3182392917. [DOI] [PubMed] [Google Scholar]
- 27.Fanning JR, Pietrzak RH. Suicidality among older male veterans in the United States: Results from the National Health and Resilience in Veterans Study. J Psychiatr Res. 2013;47(11):1766–75. doi: 10.1016/j.jpsychires.2013.07.015. [DOI] [PubMed] [Google Scholar]
- 28.Thompson JM, Sweet J, Poirier A, VanTil L. Suicide and Attempt Findings in the Survey on Transition to Civilian Life: Descriptive Analysis. Charlottetown, ON: Veterans Affairs Canada, Research Directorate Technical Report; 2011. [Google Scholar]
- 29.Bernai M, Haro JM, Bernert S, Brugha T, de Graaf R, Bruffaerts R. Risk factors for suicidality in Europe: Results from the ESEMED study. J Affect Disord. 2007;101(1-3):27–34. doi: 10.1016/j.jad.2006.09.018. [DOI] [PubMed] [Google Scholar]
- 30.Griffith JE, Vaitkus M. Armed Forces and Society. 2013. Perspectives on suicide in the Army National Guard. [Google Scholar]
- 31.Ilgen MA, Zivin K, Austin KL, Bohnert ASB, Czyz EK, Valenstein M, et al. Severe pain predicts greater likelihood of subsequent suicide. Suicide Life Threat Behav. 2010;40(6):597–608. doi: 10.1521/suli.2010.40.6.597. [DOI] [PubMed] [Google Scholar]
- 32.Bryan CJ, Hernandez AM, Allison S, Clemans T. Combat exposure and suicide risk in two samples of military personnel. J Clin Psychol. 2013;69(1):64–77. doi: 10.1002/jclp.21932. [DOI] [PubMed] [Google Scholar]