Suicide and suicidal thoughts and behaviours in Australian Defence Force veterans

What's the issue?

Suicide deaths among serving and ex-serving members of the Australian Defence Force (ADF) are significantly higher than suicide in the general Australian population.^1,2 There are a number of occupational and psycho-social factors that may influence suicidal throughs and behaviours for serving and non-serving ADF personnel.

Understanding suicidal thoughts and behaviours in ADF personnel is important for the prevention of suicide. Suicidal thoughts and behaviours (suicidality) can include suicidal ideation, suicidal thoughts of varying intensity, active plans, suicidal gestures, behaviours or attempts.

People who experience suicidality may be placed at an increased risk of suicide. Researchers aimed to synthesise the current literature landscape in Australian ADF suicide and suicidality to inform priorities for future research.

What was done?

Researchers conducted a scoping review of the literature through the PubMed/MEDLINE, Embase and CINAHL data bases. Reference lists of eligible manuscripts were searched for additional articles of relevance. Grey literature was included in the search.

• Eligible publications were restricted to those published in English.
• Research publications reporting on thoughts and behaviours along the spectrum from ideation to completed suicide were included.
• Research from all settings, including in-patient, out-patient and community samples (whether or not accessing health care), were considered for inclusion.
• Research published prior to the Vietnam war was excluded.
• There was no restriction on publication type as long as primary data collection was reported.

Researchers analysed and synthesised the findings of the publications.

What was found?

Results from the literature search found 26 publications eligible for inclusion in the review. 12 publications were associated with the Vietnam War. 14 publications were not associated with any particular conflict.

Suicide

For suicide, the literature predominately saw increased rates of suicide in ex-serving defence force personnel.

• A 2017 study by Milner et al. found that the rate of suicide for defence was 3.27 times higher than the suicide rate for other occupations in the study (ambulance, police, firefighters and prison/security officers).
• A 2022 report by the Australian Institute of Health and Welfare (AIHW, 2022) found:
  • Suicide rates were 49 per cent lower for males serving permanently in the defence force, 46 per cent lower for males in the reserves and 27 per cent higher for ex-serving males.
  • For ex-serving females, the suicide rate was 107 per cent higher than the Australian community, although it was lower in comparison to ex-serving males.

• Two studies by Duncan et al., 1974 and Adena et al., 1985 found that the suicide rate for ADF serving members was lower than the general population.

Suicidality

Analysis of the literature found that suicidality in general was higher in ex-serving ADF members.

• A study by Van Hooff et al., 2018 showed no difference in the frequency of suicide attempts between those exposed to combat and diagnosed with post-traumatic stress disorder (PTSD), and those who were not exposed to combat or were diagnosed with PTSD.
• A study by McFarlane et al., 2011 4.0 per cent of the ADF personnel had reported suicidality in the past 12 months, 3.9 per cent having thought about attempting suicide and 1.1 per cent having made a suicide plan. These figures are double that of the Australian general population for the study period.
• Van Hooff et al., 2018 and McFarlane et al., 2011 found there was no significant difference in the prevalence of suicidality between those who had deployed and those who had never deployed.
• Suicidality significantly increased in those members who had transitioned due to medical discharge rather than for other reasons Van Hooff et al., 2018, Bryant et al., 2019, AIHW, 2022
• Varker et al., 2022 found an association between anger and suicidality in ADF males.

Limitations

The researchers note that difficulty defining and capturing suicidality in the data may have impacted the findings of the review.

Why are the findings important?

Understanding factors leading to suicide and suicidality is important to inform suicide prevention strategies and develop targeted interventions for current and ex-serving defence personnel.