Suicide Rates
Severe mental illness increases suicide risk, in males and females. The study authors noted that the standardized mortality ratio in individuals with psychotic disorders is about 400% higher than the general population.
“Bipolar depression is the psychiatric condition with the highest lifetime risk for suicide across the board,” Harvey told U.S. Medicine. In this study, 51.2% of participants with bipolar disorder had attempted suicide.
Overall, veterans with SMI have at least twice the risk of suicide compared to other veterans—“and the rate of suicide in veterans in general is elevated,” Harvey emphasized.
In 2017, the suicide rate for veterans was 1.5 times that for adults who had never served on active duty, after adjusting for difference in age and sex. Veterans with severe mental illness, therefore, are in at least two higher risk groups.
But how does risk for these veterans change when viewed by gender?
“The males and females differed in too many ways to group them,” Harvey said. “The female veterans are all younger and they served in different theaters. Further, they had other characteristics such as higher education that make them different.”
Female veterans also tended to have higher incomes, fewer medical comorbidities, and were less likely to have a diagnosis of alcohol, nicotine, or drug abuse.
Gender affected nearly all the findings in the study. Female veterans reported more suicidal behavior and more suicide attempts; death due to suicide was more common in males. Medical comorbidities increased suicidal behavior only in males. Bipolar disorder was associated with increased risk of both suicidal thoughts and behaviors in females, but only with suicidal ideation in males.
African American race and marriage appeared to provide a protective effect in males, but not in females. Higher cognitive function increased the risk of suicidal ideation and behavior in males, but not in females, though the researchers noted that the smaller sample size and narrower degree of variance in cognitive function could have affected those findings.
“Given the limited representation of female veterans with severe mental illness in research studies, identifying and addressing gaps in knowledge is paramount—including for the risk of suicide,” the authors concluded. “Our results suggest that gender-based differences exist, and the underlying patterns have implications for the clinical assessment of suicide risk, as well as for policy decisions regarding mental health services.”
*The 2019 National Veteran Suicide Prevention Annual Report changed the definition of a veteran to “someone who had been activated for federal military service and was not currently serving at the time of death.” Prior reports, which showed an average of 20 suicides per day, included veterans, current service members, and former members of the National Guard and Reserve who had never been federally activated.
- Aslan M, Radhakrishnan K, Rajeevan N, Sueiro M, Goulet JL, Li Y, Depp C, Concato J, Harvey PD. Suicidal ideation, behavior, and mortality in male and female US veterans with severe mental illness. J Affect Disord. 2020 Apr 15;267:144-152. doi: 10.1016/j.jad.2020.02.022. Epub 2020 Feb 7. PubMed PMID: 32063566.