There are no recent UK-wide studies, and comparatively few international ones, examining suicide in military veterans. This is despite increasing public concern about suicide and the mental health impact of serving in the UK Armed Forces, particularly following a period of intensive operations in Iraq and Afghanistan. The recently published National Suicide Prevention Strategy for England sets out an ambition to better understand suicide rates in veterans within the next 5 years, while the 2022-2024 Veterans Strategy Action Plan outlines the steps needed to transform services and support for veterans by 2028. In this article, Drs Cathryn Rodway and Jodie Westhead, researchers at the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), explain how their work adds to the evidence base of suicide prevention in veterans of the UKAF.

• Researchers from The University of Manchester examined the risk of suicide in veterans compared to the general population, and investigated factors most associated with suicide after discharge.
• The overall risk of suicide in veterans is not higher than the general population, but young men and women leaving the Armed Forces are at higher risk, especially if they had short lengths of service.
• Improving and maintaining access to mental health care and social support for young service leavers, combined with implementing general suicide prevention measures for all veterans regardless of age, is important for suicide prevention in this group.

What was the purpose of the research and why is it important?

There is a lack of global consensus on whether past military service increases suicide risk. Research suggests veterans of the Armed Forces may be a potentially vulnerable group for many reasons, including traumatic life events prior to enlisting, unique experiences while in Service, the difficulties associated with returning to civilian life and high rates of unemployment, homelessness, and alcohol and drug misuse following discharge. In a previous 10-year study (1996-2005) of almost 234,000 people who left the Armed Forces, 0.1% died by suicide, and the overall suicide rate was no greater than in the general population.

Over 15 years have passed since then, and the military context in the UK has changed, as have patterns of suicide in the general population. There has been concern about the mental health impact of serving in conflicts in Iraq and Afghanistan, the number of full-time personnel in the Army has decreased, and there are more specialist NHS health and other third-sector support services available for veterans. It was in this new context that we undertook our latest research.

Suicide in veterans – rates and risk factors

In our recent study we looked at data for over 458,000 veterans who left the Armed Force between 1996 and 2018 (an additional 13 years of data compared to our previous study, and over 200,000 more veterans). In this 23-year period, 1,086 (0.2%) veterans tragically took their own lives. We found the overall rate of suicide in veterans was slightly lower than the general population, but identified differences according to age. Suicide risk was 2-3 times higher in male and female veterans aged under 25 compared to the same age-groups in the general population. Male veterans aged over 35 were at reduced risk of suicide.

We identified some factors which increased suicide risk in veterans, including being male, serving in the Army, having served for less than 10 years, being discharged from the military before the age of 35 years, and being untrained. However, there were also some factors which appeared protective – being married, of a higher rank, and serving in a conflict appeared to reduce suicide risk.

A quarter (273/1,086; 25%) of veterans who died by suicide had been in contact with specialist NHS mental health services in the 12 months before death (i.e., were patients), similar to the general population (27%). Of note, however, was our finding that the rate of contact with these services was lowest (21%) in the age-group most at risk (veterans aged under 25), suggesting younger veterans in particular may not be seeking help. Compared to non-veterans who died by suicide within 12 months of contact with mental health services, veterans of the Armed Forces more often had a diagnosis of depression or bipolar disorder (33% vs 27%) and evidence of PTSD, although numbers were small (3% vs 1%). There were few other differences and levels of unemployment, alcohol and drug misuse, and self-harm were similar to patients who had not served in the Armed Forces.

What does this mean for prevention?

Our research suggests the highest risk of suicide continues to be in young veterans, and young people who serve for short lengths of time may have the most pressing needs. However, 16–24-year-olds made up 18% of the total veteran population who died by suicide, compared to 26% of 40–54-year-olds (although rates were lower in the older age group), suggesting all veterans regardless of age should be the focus of prevention. The low rate of contact with specialist NHS mental health services suggests veterans may not be seeking help, or may not be aware of the help that is available.

Improving access to (and knowledge about) mental health care, and encouraging help-seeking or campaigns to reduce stigma may increase engagement in veterans. However, equipping services with the knowledge and training to better support the health of veterans and understand their culture and needs is also important, as is services having the information to signpost veterans to financial advice, housing and employment support. Implementing general suicide prevention measures like tackling self-harm, alcohol and drug misuse and enhancing social support, is as important for veterans as it is for the general population.

Delivering on these recommendations will require cross-departmental working between the Ministry of Defence (particularly the Office for Veterans Affairs), the Department of Health and Social Care, and local & national health and care services (such as the 42 Integrated Care Services in England, and OpCOURAGE, the dedicated NHS service for the Armed Forces). A clear process, developed and agreed by these stakeholders, should be in place to provide services and advice to veterans upon leaving the Armed Forces.

Our recent study is one part of understanding the causes of suicide in veterans of the Armed Forces. Further research by The University of Manchester will explore the role of pre-service or other factors that may have influenced later suicide risk, such as childhood trauma or homelessness. New methods of recording veteran suicide, announced in 2021, will also better our and service providers understanding of the needs of veterans.

This article was originally published as part of our collection on mental health and wellbeing, Open Minds. Read more evidence-led policy insight on this topic in the full online collection.