TY  - JOUR
PY  - 2019//
TI  - Suicide in Canadian veterans living in Ontario: a retrospective cohort study linking routinely collected data
JO  - BMJ open
A1  - Mahar, Alyson L.
A1  - Aiken, Alice B.
A1  - Whitehead, Marlo
A1  - Tien, Homer
A1  - Cramm, Heidi
A1  - Fear, Nicola T.
A1  - Kurdyak, Paul
SP  - e027343
EP  - e027343
VL  - 9
IS  - 6
N2  - 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>
LA  - en
SN  - 2044-6055
UR  - http://dx.doi.org/10.1136/bmjopen-2018-027343
ID  - ref1
ER  -