Click to Enlarge: Crude Hazard Rates of Suicide Among Theater, Nontheater, and All Veterans of Vietnam War Era and US Male Population by Number of Years Since Entry to Follow-Up or Calendar Year
US male population suicide rates are based on calendar year of death (obtained from CDC Wonder). Veteran suicide rates were calculated for one-year intervals from 1979 to 2019. The first year interval includes 5.5 months to 1.5 years (1 year). All subsequent rates are for time intervals that begin at midpoint and end at midpoint of the subsequent year (eg, 2 years = 1.6 years − 2.5 years). Accordingly, the separate time intervals for veterans, 1 to 41 years, cross calendar years. Crude rates for both US males and veterans are per 100 000 persons. Source: JAMA Network Open
WASHINGTON, D.C. — Veterans who served in the Vietnam War era, either in theater or not deployed, are not at increased risk of suicide mortality compared with the U.S. population, although the number of suicides among these veterans is noteworthy and merits the attention of mental health professionals and policymakers, according to a recent study.
The cohort study published in JAMA Network Open examined whether the risk of suicide among U.S. veterans who served in the Vietnam War between 1961 and 1975 was greater than that of veterans who served in the military at the same time but not in the Vietnam War theater. The study authors were affiliated with the Washington, DC; VA Palo Alto Health Care System in Menlo Park, CA; and VA Finger Lakes Healthcare System in Canandaigua, NY.1
Since the conclusion of the Vietnam War, there has been concern for suicide risk among Vietnam War-era veterans, particularly those deployed to the theaters of war, the study reported. Estimates of suicide mortality among this population have varied widely over the past 50 years, partly due to the challenges in obtaining cause-specific mortality data on the entire population of Vietnam veterans, according to study authors.
The authors, whose work focuses on the health consequences of military service, had concerns regarding the actual risk of suicide after Vietnam War-era military service. Previous research relied on samples or specific subgroups of Vietnam veterans, which led to estimates of suicide risk, the authors explained.
“This current study included all Vietnam-era veterans, both theater and non-theater, and counted suicides reported on death certificates, resulting in, we believe, the most accurate measure of suicide mortality over a four-decade period,” a VA spokesperson told U.S. Medicine.
The study authors compiled a roster of all Vietnam-era veterans, both theater and non-theater, who served between Feb. 28, 1961, and May 7, 1975, using the VA data source known as the United States Veterans Eligibility Trends and Statistics (USVETS). The authors identified about 9.6 million Vietnam War-era veterans, including 2,465,343 theater veterans and 7,122,976 non-theater veterans, the study reported.
Vietnam deployment for all Vietnam-era veterans identified in USVETS was determined by matching the veterans against the Defense Manpower Data Center’s Vietnam File, which identifies all veterans who served in Southeast Asia during the Vietnam War, the VA spokesperson explained. Death certificate data, including date and cause of death, were obtained from the VA/DoD database known as the Mortality Data Repository (MDR), which obtains cause of death from annual searches of the National Center for Health Statistics’ National Death Index. At the time of analysis, cause of death was available for deaths occurring from 1979 to 2019, the VA spokesperson said.
“While this study did not find an increased risk of suicide associated with serving in Vietnam and neither theater nor non-theater veterans had increased risks of suicide compared to the U.S. population, there were over 94,000 suicides among both theater and non-theater veterans, 22,736 and 71,761 respectively,” a VA spokesperson said. “In addition to this large number of suicides, and despite the absence of an increased risk of suicide, the suicide rates among both theater and non-theater veterans have continued to increase over 41 years. Suicide remains a health concern for Vietnam-era veterans, but one that can be prevented with the right care and support using evidence-based practices.”
After using statistical adjustment, a technique used to remove differences in risk of suicide influenced by age, sex or race in the two comparison populations, the authors found the suicide risk between 1979 to 2019 among deployed (theater) veterans was less than that of non-deployed (non-theater) veterans, the VA spokesperson explained. The Hazard Ratio (HR), a statistical technique that compares risks between groups, was 0.94; (95%, C.I., 0.93-0.96), according to the study’s results. The HR of less than 1.0 is interpreted as demonstrating a lower risk in the population of interest, which was theater veterans, the spokesperson wrote in an email.
The results bring awareness to the mental health of all veterans, especially those from the Vietnam War era.
“Given that the suicide rates among this study’s cohorts have generally increased over the past 41 years, the mental health and suicide risk of Vietnam-era veterans should continue to be addressed,” the VA spokesperson said. “It is imperative that clinicians, researchers and health policymakers within and beyond VA are aware of the persistent risk of suicide in this and other veteran cohorts, and continue efforts focused on prevention, early detection and timely intervention of suicide risk in all veterans.”
To address this issue, the study authors recommend that “outreach and suicide prevention efforts should be continued, improved and tracked.”
“Efforts to identify the mechanisms driving suicide risk in this population are needed and must be pursued vigorously to support a nuanced understanding of how to effectively implement primary, secondary and tertiary intervention and support efforts,” the VA spokesperson said.
Policymakers may find that “fostering clinical research collaborations that champion in-depth assessment (and characterization) of risk (such as social, financial and health issues) and resilience factors for suicide prevalent among aging veterans (e.g., Vietnam veterans) are helpful in guiding policy next steps,” according to the spokesperson.
A limitation of the study is the absence of mortality data before January 1979, the study reported. “The Vietnam Experience Study, a 30-year follow-up of Vietnam War-era veterans, found the highest suicide rate within the first five years of military discharge, so this current study may have underestimated the number of suicides among all Vietnam War-era veterans and missed a substantial number of veteran suicides for those who served in theater,” according to the authors.
- Bullman TA, Akhtar FZ, Morley SW, et al. Suicide Risk Among US Veterans With Military Service During the Vietnam War. JAMA Netw Open. 2023;6(12):e2347616. doi:10.1001/jamanetworkopen.2023.47616