2016 Report on suicide mortality in the Canadian Armed Forces (1995-2015): Surgeon General report.

Suicide is a tragedy and an important public health concern. Suicide prevention is a top priority for the Canadian Armed Forces (CAF). In order to better understand suicide in the CAF and refine ongoing suicide prevention efforts, the Directorate of Force Health Protection (DFHP) and the Directorate of Mental Health (DMH) regularly conduct analyses to examine suicide rates and the relationship between suicide, deployment and other potential suicide risk factors. This report is an update covering the period from 1995 to 2015.

This report describes crude suicide rates from 1995 to 2015, comparisons between the Canadian population and the CAF using Standardized Mortality Ratios (SMRs), and suicide rates by deployment history using SMRs and direct standardization. It also examines variation in suicide rate by command and, using data from the Medical Professional Technical Suicide Reviews (MPTSR), looks at the prevalence of other suicide risk factors in suicides which occurred in 2015.

Between 1995 and 2015, there were no statistically significant increases in the overall suicide rates. The number of Regular Force males that died by suicide was not statistically higher than that expected based on Canadian male suicide rates. While the suicide rate among males with a history of deployment was not significantly higher than in comparable civilians, rate ratios indicated that there was a trend for those with a history of deployment to be at an increased risk of suicide compared to those who have never been deployed; however, the difference was not statistically significant. These rate ratios also highlighted that, since 2006 and up to and including 2015, being part of the Army command significantly increases the risk of suicide, relative to those who are part of the other commands.

The most recent findings suggest a trend towards an elevated suicide rate ratio (1.48, CI: 0.98, 2.22) in the past decade in those Regular Force males with a history of deployment relative to those Regular Force males without a history of deployment. However, this finding fell just short of statistical significance. Regular Force males under Army command were at significantly increased risk of suicide relative to Regular Force males under non-Army commands (age-adjusted suicide rate ratio = 2.49, CI: 1.81, 3.42), with a trend towards a widening gap between the rates in Army and non-Army command Regular Force males over the past five years. Regular Force males under Army command in the combat arms trades had statistically significantly higher suicide rates (31.65/100,000, CI: 24.51, 40.66) than non-combat arms Regular Force males (16.52/100,000, CI: 13.48, 20.22).

Results from the 2015 MPTSRs is in support of a multifactorial causal pathway (this includes biological, psychological, interpersonal, and socio-economic factors) to suicide rather than a direct link between single risk factors (e.g. Post-Traumatic Stress Disorder (PTSD) or deployment) and suicide.

Suicide rates in the CAF did not significantly increase over time, and after age standardization, they were not statistically higher than those in the Canadian population. However, small numbers have limited the ability to detect statistical significance. History of deployment continues to be a possible risk factor for suicide in the CAF. The increased risk in Regular Force males under Army command compared to Regular Force males under non-Army command is another recent finding. Deployment-related trauma (especially that related to the mission in Afghanistan) and resulting mental disorders are plausible mechanisms for these associations. However, residual confounding may also be at play (e.g. by disproportionate risk of childhood trauma or other lifetime trauma in Army personnel or those who deploy). Further research with other data sources will be needed to explore these hypotheses in depth.

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