Relation between Traumatic Events and Suicide Attempts in Canadian Military Personnel

Article excerpt

Objective: To determine whether exposure to particular types of traumatic events was differentially associated with suicide attempts in a representative sample of active military personnel.

Method: Data came from the Canadian Community Health Survey: Mental Health and Well-Being Canadian Forces Supplement (CCHS-CFS), a cross-sectional survey that provided a comprehensive examination of mental disorders, health, and the well-being of currently active Canadian military personnel (n = 8441; aged 16 to 54 years; response rate 81.1%). Respondents were asked about exposure to 28 traumatic events that occurred during their lifetime. Suicide attempts were measured using a question about whether the person ever "attempted suicide or tried to take [his or her] own life."

Results: The prevalence of lifetime suicide attempts for currently active Canadian military men and women was 2.2% and 5.6%, respectively. Sexual and other interpersonal traumas (for example, rape, sexual assault, spousal abuse, child abuse) were significantly associated with suicide attempts in both men (adjusted odds ratios [AORs] ranging from 2.31 to 4.43) and women (AORs ranging from 1.73 to 3.71), even after adjusting for sociodemographics and mental disorders. Additionally, the number of traumatic events experienced was positively associated with increased risk of suicide attempts, indicating a dose-response effect of exposure to trauma.

Conclusions: The current study is the first to demonstrate that sexual and other interpersonal traumatic events are associated with suicide attempts in a representative sample of active Canadian military men and women.

Can J Psychiatry. 2009;54(2):93-104.

Clinical Implications

* Clinicians working with military populations should be aware of the presence of a traumatic experience in addition to development of a psychiatric disorder in determining the likelihood of a lifetime suicide attempt.

* Clinicians working with military populations should specifically inquire about lifetime exposure to sexual and other interpersonal traumatic experiences owing to its association with lifetime suicide attempts.

* Deployment-related traumatic experiences do not appear to confer additional likelihood of a lifetime suicide attempt above and beyond the presence of development of a psychiatric disorder.

Limitations

* The CCHS-CFS survey did not provide additional information about the exact nature of the traumatic event, including whether the experience was deployment-related.

* Findings may not be generalizable to other military populations, considering that other military groups may have different levels of exposure to combat and other traumatic events.

* Owing to the cross-sectional nature of the survey, causal inferences cannot be made.

Key Words: suicide, attempts, traumatic events, military, Canadian, trauma, representative

Abbreviations used in this article

CCHS-CFS Canadian Community Health Survey: Mental Health and Well-Being Canadian Forces Supplement

CIDI Composite International Diagnostic Interview

DSM Diagnostic and Statistical Manual of Mental Disorders

PTSD posttraumatic stress disorder

WMH World Mental Health

There has been increasing concern about the mental health of soldiers during recent years. Importantly, suicide has been noted as the second most common cause of death in the United States military1 and has increasingly become the focus of research in military groups because of its public health impact. Recent research suggests that veterans are more than twice as likely to die by suicide, compared with the general population.2 This finding has been corroborated in several military samples3"5; however, other studies have demonstrated conflicting results.6-10 To date, it is unclear whether military personnel have an increased or decreased risk of suicidal behaviour.

Considering evidence that a prior suicide attempt is among the best predictors of subsequent completed suicide11 and that suicide attempts are prevalent in the community,12 it is critical to identify risk factors for suicide attempts in a military population. …