Risk of Suicide Among US Military Service Members Following Operation Enduring Freedom or Operation Iraqi Freedom Deployment and Separation From the US Military
Abstract
IMPORTANCE: A pressing question in military suicide prevention research is whether deployment in support of Operation Enduring Freedom or Operation Iraqi Freedom relates to suicide risk. Prior smaller studies report differing results and often have not included suicides that occurred after separation from military service. OBJECTIVE: To examine the association between deployment and suicide among all 3.9 million US military personnel who served during Operation Enduring Freedom or Operation Iraqi Freedom, including suicides that occurred after separation. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort design used administrative data to identify dates of deployment for all service members (October 7, 2001, to December 31, 2007) and suicide data (October 7, 2001, to December 31, 2009) to estimate rates of suicide-specific mortality. Hazard ratios were estimated from time-dependent Cox proportional hazards regression models to compare deployed service members with those who did not deploy. MAIN OUTCOMES AND MEASURES: Suicide mortality from the Department of Defense Medical Mortality Registry and the National Death Index. RESULTS: Deployment was not associated with the rate of suicide (hazard ratio, 0.96; 99% CI, 0.87-1.05). There was an increased rate of suicide associated with separation from military service (hazard ratio, 1.63; 99% CI, 1.50-1.77), regardless of whether service members had deployed or not. Rates of suicide were also elevated for service members who separated with less than 4 years of military service or who did not separate with an honorable discharge. CONCLUSIONS AND RELEVANCE: Findings do not support an association between deployment and suicide mortality in this cohort. Early military separation (<4 years) and discharge that is not honorable were suicide risk factors.
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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 [18]
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 [18]
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- Authors
- Reger, M. A., Smolenski, D. J., Skopp, N. A., Metzger-Abamukang, M. J., Kang, H. K., Bullman, T. A., Perdue, S., & Gahm, G. A.
- Affiliations
- National Center for Telehealth and Technology, Joint Base Lewis-McChord, Tacoma, Washington
- Veterans Health Administration (US)
- United States Department of Veterans Affairs (US)
- University of Washington Tacoma (US)
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2015-06-01
- Volume
- 72
- Issue
- 6
- Pages
- 561
- ISSN
- 2168-622X (ISSN-L)
- OpenAlex
- W2098906627
- Cited by
- 222
- References
- 32
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 21 · 2023: 18 · 2022: 21 · 2021: 18 · 2020: 25 · 2019: 17 · 2018: 25 · 2017: 24 · 2016: 29 · 2015: 12
- FWCI
- 37.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- University of Washington Tacoma Digital Commons (University of Washington Tacoma) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Performance
- Keywords
- military suicide, suicide mortality, Operation Enduring Freedom, Iraq War, military deployment, military separation, honorable discharge, length of service, suicide risk factors, US military personnel
- MeSH terms
- Adolescent, Adult, Female, Humans, Male, Middle Aged, Military Personnel, Retrospective Studies, Risk Factors, Suicide, United States, Veterans, Proportional Hazards Models, Databases, Factual, Iraq War, 2003-2011, Young Adult, Afghan Campaign 2001-
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