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American Journal of Epidemiology Advance Access originally published online on July 7, 2009
American Journal of Epidemiology 2009 170(4):494-500; doi:10.1093/aje/kwp164
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Suicide Among US Veterans: A Prospective Study of 500,000 Middle-aged and Elderly Men

Matthew Miller*, Catherine Barber, Deborah Azrael, Eugenia E. Calle {dagger}, Elizabeth Lawler and Kenneth J. Mukamal

* Correspondence to Dr. Matthew J. Miller, Department of Health Policy and Management, Harvard School of Public Health, Room 305, Kresge Building, 677 Huntington Avenue, Boston, MA 02115 (e-mail: mmiller{at}hsph.harvard.edu).

Received for publication March 10, 2009. Accepted for publication May 19, 2009.

Expert opinion is divided about whether US military veterans, the vast majority of whom are middle-aged or older, are at increased risk of suicide. To assess the risk of suicide associated with veteran status, the authors conducted a prospective cohort study of 499,356 male participants in the Cancer Prevention Study II. Participants reported their veteran status and other characteristics in 1982 and were followed for mortality through 2004. The relative risk of mortality from suicide according to veteran status at baseline was estimated by using Cox proportional hazards models. During follow-up, 1,248 veterans and 614 nonveterans died by suicide. In age-adjusted analyses, the risk of suicide did not differ by veteran status. Additional adjustment for several sociodemographic, behavioral, and clinical factors had little effect on hazard ratios. The authors concluded that the risk of death from suicide among middle-aged and older US males is independent of veteran status and suggest that policies to prevent veteran suicide should focus on factors that may heighten suicide risk rather than on veteran status per se.

cohort studies; firearms; suicide, veterans

Abbreviations: CPS-II, Cancer Prevention Study II; NHIS–NDI, National Health Interview Survey–National Death Index

{dagger} Deceased.


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