Caroline Cassels

May 27, 2009

May 27, 2009 — (San Francisco, California) Women veterans are 2 to 3 times more likely to commit suicide than nonveteran women. Furthermore, female veterans are more likely to be young and use firearms to commit suicide compared with their civilian counterparts, who tend to choose other methods — commonly drug overdose.

Presented here at the American Psychiatric Association 162nd Annual Meeting, 2 studies — a small longitudinal study and a much larger, cross-sectional study — show that suicide risk is high among this growing population.

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Dr. Bentson McFarland Discusses New Data on Suicide Among Female Veterans

"The relative risk, especially in the longitudinal study, was quite high — 3-fold is a very high relative risk in epidemiology, and that finding was surprising to many of us," study investigator Bentson McFarland, MD, PhD, from Oregon Health and Science University, in Portland, told Medscape Psychiatry.

A Growing Concern

Suicide in this population, said Dr. McFarland, is a growing concern. The number of women in the United States military has increased dramatically in the past number of years, and women now make up roughly 10% to 15% of active service members; the numbers of women veterans in the United States is approaching 2 million.

"Previous studies have suggested that male veterans are at more than twice the risk of suicide compared with nonveteran males. We wanted to look at women who have been in the military to see if they were also at elevated risk," Dr. McFarland told conference attendees.

A 2007 longitudinal study of women veterans, the investigators revealed, which followed individuals for a period of 12 years, suggested that women who have been in the military had a 3-fold increased risk for suicide compared with nonmilitary women. Data for this study came from the National Health Interview Study and was then linked with data from the National Death Index.

It is important to note, said Dr. McFarland, that this study was population-based and therefore the findings are generalizable to all military personnel and not just those in the Veterans Affairs (VA) health system.

He pointed out that research conducted by the Department of Veterans Affairs in 2001 revealed that the vast majority of veterans (76.6%) receive all of their healthcare services outside of the VA system.

While male veterans had a 2-fold increased risk for suicide compared with nonveteran males, the study revealed that women had a more than 3-fold increased risk (HR, 3.62) compared with nonmilitary women.

However, said Dr. McFarland the numbers were small and included 11 suicides among female veterans and 246 in nonveteran females.

Nevertheless, with this strong signal of increased suicide risk, the investigators set out to determine whether the findings could be replicated in a large, cross-sectional, population-based study.

Young Women at Greatest Risk

For the second study, the researchers used data from the Centers for Disease Control and Prevention National Violent Death Reporting System. This database was started in 2003 and aggregates information from death certificates and coroner/medical-examiner data from 17 participating states.

The information provided also includes a direct question about whether individuals have ever served in the military, as well as substantial information about the decedents, including cause of death.

The study results revealed that from 2003 to 2006 there were 171 female veteran suicide cases vs 5174 nonveteran female suicides. A total of 75 (44%) women veterans shot themselves, and 96 (56%) died by other methods. In contrast, 33% of nonveteran women died by firearms. The odds ratio for suicide for female veterans vs other women was 1.79.

In addition, suicide among nonveteran women was greatest between the ages of 35 and 64 years. In contrast, the peak age for suicide among military women was much younger — between 18 and 34 years.

"Women veterans are at about 79% greater risk of suicide than nonveteran women, and this risk varies markedly by age. The bottom line for clinicians is that even if you are outside the Veterans Affairs system, you will be seeing veterans in your practice, and some of them will be women who may well be at elevated risk of suicide," said Dr. McFarland.

"Clinicians should ask their female patients about military service and also inquire about low mood and difficulty with sleep or appetite, as well as problems with substance abuse, thoughts about suicide, and access to firearms," he added.

The study was supported by the National Institute of Mental Health and the American Foundation for Suicide Prevention Distinguished Investigator Award.

American Psychiatric Association 162nd Annual Meeting: Abstract SCR 21-61. Presented May 20, 2009.

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