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Few studies of veterans have examined cardiovascular disease as the primary outcome, other than in relation to specific conflicts or hazards. To assess the long-term risk and prognosis of acute myocardial infarction (AMI) in United Kingdom veterans from a broad range of military backgrounds and experience, we conducted a retrospective cohort study of 57,000 veterans resident in Scotland and 173,000 civilians matched on age, sex, and area of residence. Cox proportional hazards models were used to compare the risks of fatal/nonfatal AMI overall, by sex, and by year of birth, adjusting for the potentially confounding effect of socioeconomic status, and to compare rates of case-fatality following AMI at 30-day, 1-year, and 5-year follow-up. Over a mean follow-up period of 29 years between 1981 and 2012, a total of 2,106 (3.8%) veterans experienced an AMI as compared with 5,261 (3.1%) nonveterans (hazard ratio = 1.22, 95% confidence interval: 1.16, 1.29; P < 0.001). There was an increased risk of AMI among veterans born in 1945-1959 but not among those born from 1960 onward. Case-fatality was lower among veterans at 30-day, 1-year, and 5-year follow-up. We conclude that health behaviors such as smoking may have increased the risk of AMI in older veterans but that younger veterans have benefited from in-service health promotion initiatives.

ObjectivesThe risk of suicide among UK military veterans remains unclear. Few recent studies have been undertaken, and most studies found no clear evidence of increased risk. We used data from the Trends in Scottish Veterans Health cohort to investigate suicides up to 2017 in order to examine whether there have been any changes in the long-term pattern of veteran suicides since our earlier study to 2012, and to compare trends in the risk of suicide among veterans with matched non-veterans.MethodRetrospective cohort study of 78 000 veterans and 253 000 non-veterans born between 1945 and 1995, matched for age, sex and area of residence, using survival analysis to examine the risk of suicide in veterans in comparison with non-veterans overall and by subgroup, and to investigate associations with specific mental health conditions.ResultsUp to 37 years of follow-up, 388 (0.5%) veterans and 1531 (0.6%) non-veterans died from suicide. The risk of suicide among veterans did not differ from non-veterans overall. Increased risk among early service leavers was explained by differences in deprivation, and the previously reported increased risk in female veterans is now confined to older women. Suicide was most common in the fifth decade of life, and around 20 years postservice. A history of mood disorder or post-traumatic stress disorder was non-significantly more common in veterans.ConclusionsVeterans are not at increased risk of suicide overall. The highest risk for both men and women is in middle age, many years after leaving service.

Background: Although reassuring data on suicide risk in UK veterans of the 1982 Falklands

Purpose Although suicide risk in veterans has been widely studied, there is little information on the risk of non-fatal selfharm in this population. We used data from the Scottish Veterans Health Study to conduct an epidemiological analysis of self-harm in veterans, in comparison with people who have never served. Methods We conducted a retrospective, 30-year cohort study of 56,205 veterans born 1945-1985, and 172,741 people with no record of military service, and used Cox proportional hazard models to examine the association between veteran status and cumulative risk of non-fatal self-harm, overall and stratified by birth cohort, sex and length of service. We also examined mental and physical comorbidities, and association of suicide with prior self-harm. Results There were 1620 (2.90%) first episodes of self-harm in veterans, compared with 4212 (2.45%) in non-veterans. The difference was statistically significant overall (unadjusted HR 1.27, 95% CI 1.21-1.35, p < 0.001). The risk was highest in the oldest veterans, and in the early service leavers who failed to complete initial training (unadjusted HR 1.69, 95% CI 1.50-1.91, p < 0.001). The risk reduced with longer service and in the intermediate birth cohorts but has increased again in the youngest cohort. Conclusions The highest risk of non-fatal self-harm was in veterans with the shortest service, especially those who did not complete training or minimum engagement, and in the oldest birth cohorts, whilst those who had served the longest were at reduced risk. The risk has increased again in the youngest veterans, and further study of this subgroup is indicated.