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Cited by 91Suicide and Self-Harm StudiesEducation and Military IntegrationOccupational Health and Performance

Association of Suicide Risk With Transition to Civilian Life Among US Military Service Members

Open access
Ravindran, Chandru, Morley, Sybil W., Stephens, Brady M., Stanley, Ian H., Reger, Mark A.·2020·JAMA Network Open
DOI 10.1001/jamanetworkopen.2020.16261PMC PMC7489860
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Abstract

Importance: Although interest is high in addressing suicide mortality after the transition from military to civilian life, little is known about the risk factors associated with this transition. To support the ongoing suicide surveillance work of the US Department of Veterans Affairs (VA) Office of Mental Health and Suicide Prevention, examining these factors is important for targeting suicide prevention efforts. Objective: To examine the prevalence, patterns, and associated characteristics of suicide mortality among US service members after separation from military active status. Design, Setting, and Participants: This retrospective population-based cohort study obtained demographic and military service data from the VA/Department of Defense Identity Repository. Individuals who served on active duty in the US Army, Navy, Air Force, Marine Corps, or Coast Guard after September 11, 2001, and who separated from active status between January 1, 2010, and December 31, 2017, were included in the cohort. Data analyses were conducted from September 9, 2019, to April 1, 2020. Main Outcomes and Measures: Suicide mortality within 6 years after separation from military service. Results: A total of 1 868 970 service members (1 572 523 men [84.1%]; mean [SD] age at separation, 30.9 [9.9] years) separated from the military during the study period. Through the end of the study period (December 31, 2017), 3030 suicides (2860 men and 170 women) were identified as having occurred within 6 years of separation from the military. Statistically significant differences in suicide risk were found by demographic and military service characteristics. Suicide rates after separation were time dependent, generally peaking 6 to 12 months after separation and declining only modestly over the study period. Male service members had a statistically significantly higher hazard of suicide than their female counterparts (hazard ratio [HR], 3.13; 95% CI, 2.68-3.69). Younger individuals (aged 17-19 years; HR, 4.46 [95% CI, 3.71-5.36]) had suicide hazard rates that were approximately 4.5 times higher than those who transitioned at an older age (≥40 years). Service branch remained a risk factor for suicide even 6 years after separation; those who separated from the Marine Corps (HR, 1.55; 95% CI, 1.36-1.78) and the Army (HR, 1.48; 95% CI, 1.31-1.67) had a higher hazard than those who transitioned from the Air Force. The hazard for those who separated from the active component was higher than for those who separated from the reserve component (HR, 1.29; 95% CI, 1.18-1.42). Service members with a shorter length of service had a higher hazard (HR, 1.26; 95% CI, 1.11-1.42) than those with a longer service history. Conclusions and Relevance: Results of this study show that not all service members who recently transitioned from military life had the same risk of suicide. The data suggest that awareness of military service and demographic characteristics can help identify those most at risk for suicide to target prevention efforts.

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  • Suicidality is elevated among veterans in Australia, U.S. and UK, and documented suicide rates are significantly higher among veterans compared to both serving members and the general population.

    “Suicidality has also been shown to be elevated among veterans in Australia, U.S. and UK [16–18], with documented suicide rates shown to be significantly higher among veterans when compared to both serving members and the general population [19].”

    From Feasibility, acceptability, and initial outcomes of a psychological adjustment and reintegration program for transitioned military veterans (2024) · cites this paper as [17]

    The Discussion (page unavailable) says veterans have higher suicide rates after leaving the military than active service members, and the Introduction reports an approximately 2.5-fold higher rate in the first year after separation. The cited paper does not establish the claimed comparison with the general population. The Australia, US, and UK statement is attached to other citations, not this one. (LLM, conf=0.86)

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  • An evidence-based adjustment and reintegration program has the potential to lessen the substantial burden of negative psychosocial outcomes in the veteran community that have been associated with transition out of military service.

    “An evidence-based adjustment and reintegration program has the potential to lessen the substantial burden of negative psychosocial outcomes in the veteran community that have been associated with transition out of military service [15, 17, 18, 61].”

    From Feasibility, acceptability, and initial outcomes of a psychological adjustment and reintegration program for transitioned military veterans (2024) · cites this paper as [17]

    The Introduction and Discussion (pages unavailable) describe adjustment challenges after military separation and elevated suicide risk among transitioning veterans. The Conclusions suggest that prevention efforts may help, but the paper does not evaluate an evidence-based adjustment and reintegration program or show that one lessens the broader range of negative psychosocial outcomes. (LLM, conf=0.86)

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Authors
Ravindran, C., Morley, S. W., Stephens, B. M., Stanley, I. H., & Reger, M. A.
Affiliations
  • Canandaigua VA Medical Center (US)
  • VA Puget Sound Health Care System (US)
  • University of Washington (US)
Corresponding author
Reger, Mark A.
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2020-09-11
Volume
3
Issue
9
Pages
e2016261
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2020.16261
PMC
PMC7489860
OpenAlex
W3086343324
Cited by
91
References
17
Citations by year
2026: 14 · 2025: 17 · 2024: 20 · 2023: 20 · 2022: 13 · 2021: 7
FWCI
4.00
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Education › Education and Military Integration
  • Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Performance
Keywords
suicide mortality, military personnel, transition to civilian life, military-to-civilian transition, suicide risk factors, suicide prevention, sex differences in suicide, military branches, suicide surveillance, Department of Veterans Affairs, suicide prevention funding, suicide prevention workforce, suicide prevention research funding, suicide prevention training, suicide prevention education
MeSH terms
Adult, Female, Humans, Male, Retrospective Studies, Risk Factors, Suicide, United States, Cohort Studies, Prevalence, Proportional Hazards Models, Risk Assessment, Military Facilities

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