Suicide in war veterans: the role of comorbidity of PTSD and depression

Abstract

Many wars have been fought during the history of civilization. Approximately 30 armed conflicts are currently occurring around the globe, involving more than 25 countries. There are millions of war veterans around the world, many of whom are suffering from the psychological and/or physical wounds of war. Suicidal behavior is a major problem among war veterans. It has been estimated that from time of discharge until the early 1980s, between 8000 and 9000 Vietnam veterans died by suicide. In 2002, British veterans of the 3-month Falklands conflict (1982) claimed that more Falklands veterans had died by suicide (n = 264) since the conflict ended than died during the conflict itself (n = 256). Suicides among active-duty soldiers in the US Army reached a 28-year high in 2008, continuing a 4-year trend that has persisted despite ongoing military efforts to curb such deaths. Approximately two-thirds of the 446 soldiers who have committed suicide since 2005 have done so during deployment or after returning from deployment to Iraq or Afghanistan. In addition to experiencing elevated rates of suicide, nonfatal suicide attempts and suicidal ideation occur at high rates among veterans. Among a large national sample of patients seeking substance abuse treatment at the US Veterans’ Administration Hospitals, 4% reported a nonfatal suicide attempt in the past month. Studies have consistently demonstrated that there is an increased risk of accidental death in military populations exposed to war and trauma. Many of the accidental deaths occurring in war veterans may actually be suicidal deaths. Many war veterans suffer from post-traumatic stress disorder (PTSD), depression or both disorders. The majority of US soldiers in Iraq were exposed to some kind of traumatic, combat-related situations, such as being attacked or ambushed (92%), seeing dead bodies (94.5%), being shot at (95%) and/or knowing someone who was seriously injured or killed (86.5%). Repeated deployments are difficult for many service members. In 2006, a US government team collected data from surveys and qualitative interviews from more than 1300 soldiers and nearly 450 marines. Soldiers deployed several times to Iraq were more likely to fulfill criteria for acute stress, PTSD, depression or any mental disorder than those who were deployed once. Soldiers deployed several times were 1.6-times more likely to screen positive for PTSD than those who were deployed once and were 1.7-times more likely to have depression. Importantly, no specific cut-off for duration of deployment eliminated the risk. Suicidal behavior among war veterans may frequently be related to depression and/or PTSD. The risk of suicide attempts among the PTSD population is six-times greater than in the general population and even higher among treatment-seeking war veterans with PTSD. In one study, veterans were assessed for suicidal thinking and behavior, as well as symptoms of PTSD and depression. Thoughts of ending one’s life and a previous suicide attempt were significantly correlated with a diagnosis of PTSD. Veterans with a diagnosis of PTSD and major depressive disorder (MDD) or dysthymia were also more likely to report suicidal thinking and behaviors than veterans with only one of the diagnoses. The percentage of veterans who die from combat-related injuries is decreasing over time (22% in World War II to 16% in Vietnam to 8.8% in the recent wars in Iraq and Afghanistan), suggesting that there is now a larger proportion of veterans living with the effects of their injuries. Veterans who have activity limitations are more likely to die by suicide than veterans who do not have such limitations. Language: en