title: Trends in suicidal behaviour and use of mental health services in Canadian military and civilian populations.
abstract: BACKGROUND
  In the context of the Canadian mission in Afghanistan, substantial media attention has been placed on mental health and lack of access to treatment among Canadian Forces personnel. We compared trends in the prevalence of suicidal behaviour and the use of mental health services between Canadian military personnel and the general population from 2002 to 2012/13.
  
  
  METHODS
  We obtained data for respondents aged 18-60 years who participated in 4 nationally representative surveys by Statistics Canada designed to permit comparisons between populations and trends over time. Surveys of the general population were conducted in 2002 (n = 25 643) and 2012 (n = 15 981); those of military personnel were conducted in 2002 (n = 5153) and 2013 (n = 6700). We assessed the lifetime and past-year prevalence of suicidal ideation, plans and attempts, as well as use of mental health services.
  
  
  RESULTS
  In 2012/13, but not in 2002, military personnel had significantly higher odds of both lifetime and past-year suicidal ideation than the civilian population (lifetime: adjusted odds ratio [OR] 1.32, 95% confidence interval [CI] 1.17-1.50; past year: adjusted OR 1.34, 95% CI 1.09-1.66). The same was true for suicidal plans (lifetime: adjusted OR 1.64, 95% CI 1.35-1.99; past year: adjusted OR 1.66, 95% CI 1.18-2.33). Among respondents who reported past-year suicidal ideation, those in the military had a significantly higher past-year utilization rate of mental health services than those in the civilian population in both 2002 (adjusted OR 2.02, 95% CI 1.31-3.13) and 2012/13 (adjusted OR 3.14, 95% CI 1.86-5.28).
  
  
  CONCLUSIONS
  Canadian Forces personnel had a higher prevalence of suicidal ideation and plans in 2012/13 and a higher use of mental health services in 2002 and 2012/13 than the civilian population.
authors.affiliation: Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont. sareen@cc.umanitoba.ca.
authors.forename: Jitender
authors.initials: J
authors.lastname: Sareen
authors.affiliation: Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
authors.forename: Tracie O
authors.initials: TO
authors.lastname: Afifi
authors.affiliation: Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
authors.forename: Tamara
authors.initials: T
authors.lastname: Taillieu
authors.affiliation: Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
authors.forename: Kristene
authors.initials: K
authors.lastname: Cheung
authors.affiliation: Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
authors.forename: Sarah
authors.initials: S
authors.lastname: Turner
authors.affiliation: Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
authors.forename: Shay-Lee
authors.initials: SL
authors.lastname: Bolton
authors.affiliation: Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
authors.forename: Julie
authors.initials: J
authors.lastname: Erickson
authors.affiliation: Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
authors.affiliation: Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
authors.forename: Deniz
authors.initials: D
authors.lastname: Fikretoglu
authors.affiliation: Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Zamorski
mesh_terms: D000328:Adult; D002170:Canada; D005260:Female; D006306:Health Surveys; D000066505:Help-Seeking Behavior; D006801:Humans; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology*; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000706:statistics & numerical data* / Q000639:trends*