Combat Exposure and Risk of Suicide Attempt Among Danish Army Military Personnel

Abstract

Objective:The aim of this study was to estimate the association between self-reported perceived danger during deployment, measured as combat exposure or witnessing the consequences of war, and post-deployment suicide attempts among military personnel. Furthermore, the effect of post-deployment symptoms of posttraumatic stress disorder (PTSD) and/or depression on the risk of suicide attempts was also evaluated.Methods: This observational cohort study included Danish Army military personnel who returned from deployment in international missions from 1998 to 2016 and had completed a post-deployment questionnaire. Perceived exposure to danger was ascertained by self-report. Data on suicide attempt were retrieved from national registers. Adjusted Cox regression analyses were used to evaluate if military personnel indicating high level of combat exposure were more likely to have attempted suicides post-deployment than military personnel with lower levels of combat exposure.Results: Eighty-three suicide attempts were registered after homecoming among 12,218 military personnel. Perceived higher exposure to combat was associated with the risk of suicide attempt (hazard ratio = 1.08; 95% CI, 1.01-1.16). Furthermore, the association between combat exposure and suicide attempt was fully mediated by post-deployment symptoms of PTSD and/ or depression. No association was found between witnessing consequences of war and the risk of post-deployment suicide attempt.Conclusions: This nationwide study found that combat exposure was associated with an increased risk of suicide attempt among military personnel. This association was, however, fully mediated by mental disorders (PTSD and/or depression). These findings suggest that better psychological follow-up of military personnel identified as having PTSD and/or depression may be warranted.

Prevention of suicide and suicide attempts in the Nordic countries

“…Swedish residents who were evacuated from the 2004 tsunami in Southeast Asia had a higher rate of suicide attempts when compared to other Swedish residents, while accounting for relevant confounders (Arnberg, et al, 2015). Other crises situations are witness by military conscripts; veterans who reported combat exposure during military deployment had higher risks of suicide attempt, yet this association was found to be explained through presence of PTSD and other mental disorders (Vedtofte, et al, 2021).…”

“…Asylum-seekers (unaccompanied minors) (Mittendorfer- Rutz, et al, 2020) Childhood adversities (Björkenstam, et al, 2017) Combat exposure (Vedtofte, et al, 2021) Death of parent or family relative (Mogensen, et al, 2016a, Burrell, et al, 2018, Burrell, et al, 2021 Divorce (Fjeldsted, et al, 2016) Fertility problems (Kjaer, et al, 2011) Financial hardship (Rojas, 2021, Rojas & Stenberg, 2016 Homelessness Incarceration (Morthorst, et al, 2021a) Induced abortion (Gissler, et al, 2015) Job insecurity (Blomqvis, et al, 2022) Natural disasters (Arnberg, et al, 2015) Loss of job (Blomqvis, et al, 2022) Onset of chronic disorder (Stenager, et al, 2020) Onset of mental disorder (Aaltonen, et al, 2018, Reutfors, et al, 2009 Residential instability (Qin, et al, 2009) Release from prison (Webb, et al, 2011) Suicide of parent or family relative (Erlangsen, et al, 2017a, Ranning, et al, 2022a, Tidemalm, et al, 2011 Suicide attempt of parent (Ranning, et al, 2022a) Victim of bullying (Landstedt & Gillander, 2011, Conway, et al, 2022 -Victims of violence and sexual assault (Dufort, et al, 2015, Gradus, et al, 2012…”

Danish Veteran Challenges and Support Structures: An Overview to Enable Transnational Analysis

“…A similar number of suicides occurs in the Danish population as a whole, which suggests that veterans are not at greater risk of committing suicide than civilians (Ritzau, 2016; The Danish Veteran Centre, 2020a). However, suicide attempts increase from combat exposure, which is fully mediated by symptoms of PTSD and depression (Vedtofte et al, 2021), and veterans commit suicide with guns more often than the civilian population (Vedtofte, 2016). A recent data collection reveals 83 suicide attempts among 12,000 veterans (Jørgensen & Lyk-Jensen, 2022).…”