title: Suicide risk among 1.3 million veterans who were on active duty during the Iraq and Afghanistan wars.
abstract: OBJECTIVE
  We conducted a retrospective cohort mortality study to determine the postservice suicide risk of recent wartime veterans comparing them with the US general population as well as comparing deployed veterans to nondeployed veterans.
  
  
  METHODS
  Veterans were identified from the Defense Manpower Data Center records, and deployment to Iraq or Afghanistan war zone was determined from the Contingency Tracking System. Vital status of 317,581 deployed and 964,493 nondeployed veterans was followed from the time of discharge to December 31, 2009. Underlying causes of death were obtained from the National Death Index Plus.
  
  
  RESULTS
  Based on 9353 deaths (deployed, 1650; nondeployed, 7703), of which 1868 were suicide deaths (351; 1517), both veteran cohorts had 24% to 25% lower mortality risk from all causes combined but had 41% to 61% higher risk of suicide relative to the US general population. However, the suicide risk was not associated with a history of deployment to the war zone. After controlling for age, sex, race, marital status, branch of service, and rank, deployed veterans showed a lower risk of suicide compared with nondeployed veterans (hazard ratio, 0.84; 95% confidence interval, 0.75-0.95). Multiple deployments were not associated with the excess suicide risk among deployed veterans (hazard ratio, 1.00; 95% confidence interval, 0.79-1.28).
  
  
  CONCLUSIONS
  Veterans exhibit significantly higher suicide risk compared with the US general population. However, deployment to the Iraq or Afghanistan war, by itself, was not associated with the excess suicide risk.
authors.affiliation: Institute for Clinical Research, Washington, DC.
authors.forename: Han K
authors.initials: HK
authors.lastname: Kang
authors.affiliation: Office of Public Health, US Department of Veterans Affairs, Washington, DC. Electronic address: tim.bullman@va.gov.
authors.forename: Tim A
authors.initials: TA
authors.lastname: Bullman
authors.affiliation: National Center for Telehealth and Technology, US Department of the Army, Tacoma, WA.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Smolenski
authors.affiliation: National Center for Telehealth and Technology, US Department of the Army, Tacoma, WA.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Skopp
authors.affiliation: National Center for Telehealth and Technology, US Department of the Army, Tacoma, WA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Gahm
authors.affiliation: National Center for Telehealth and Technology, US Department of the Army, Tacoma, WA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Reger
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000367:Age Factors; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013405:Suicide / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Hazard ratios; Iraq and Afghanistan wars; Standardized mortality ratios; Suicide; Veterans