@article{ref1,
title="Suicide in Canadian veterans living in Ontario: a retrospective cohort study linking routinely collected data",
journal="BMJ open",
year="2019",
author="Mahar, Alyson L. and Aiken, Alice B. and Whitehead, Marlo and Tien, Homer and Cramm, Heidi and Fear, Nicola T. and Kurdyak, Paul",
volume="9",
number="6",
pages="e027343-e027343",
abstract="OBJECTIVES: To compare the risk of death by suicide in male veterans with age-matched civilians. <br><br>DESIGN: Retrospective cohort study linking provincial administrative databases between 1990 and 2013 with follow-up complete until death or December 31, 2015. SETTING: Population-based study in Ontario, Canada. PARTICIPANTS: Ex-serving Canadian Armed Forces and Royal Canadian Mounted Police veterans living in Ontario who registered for provincial health insurance were included. A civilian comparator group was matched 4:1 on age and sex. MAIN OUTCOME: Death by suicide was classified using standard cause of death diagnosis codes from a provincial registry of mandatory data collected from death certificates. Fine and Gray sub-distribution hazards regression compared the risk of death by suicide between veterans and civilians. Analyses were adjusted for age, residential region, income, rurality and major physical comorbidities. <br><br>RESULTS: 20 397 male veterans released to Ontario between 1990 and 2013 and 81 559 age-sex matched civilians were included. 4.2% of veterans died during the study time frame, compared with 6.5% of the civilian cohort. Death by suicide was rare in both cohorts, accounting for 4.6% and 3.6% of veteran and civilian deaths, respectively. After adjustment for confounders, veterans had an 18% lower risk of dying from causes other than suicide (HR 0.82, 95% CI 0.76 to 0.89) and a similar risk of dying by suicide (HR 1.01, 95% CI 0.71 to 1.43), compared with civilians. <br><br>CONCLUSIONS: Deaths by suicide were rare in male veterans residing in Ontario. Our findings demonstrate that veterans had a similar risk of suicide-related mortality as an age-matched civilian population. A better understanding of effective suicide prevention as well as clarifying pathways to seeking and receiving mental health supports and services are important areas for future consideration.<br><br>© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.<p /> <p>Language: en</p>",
language="en",
issn="2044-6055",
doi="10.1136/bmjopen-2018-027343",
url="http://dx.doi.org/10.1136/bmjopen-2018-027343"
}