2020 Report on suicide mortality in the Canadian Armed Forces (1995 to 2019): Surgeon General Report

Introduction: Each death from suicide is tragic. Suicide prevention is an important public health concern and 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 Canadian Forces Health Services annually examine suicide rates and the relationship between suicide, deployment and other potential suicide risk factors. This analysis, conducted by the Directorate of Mental Health (DMH), is an update covering the period from 1995 to 2019.

Methods: This report describes crude suicide rates from 1995 to 2019, 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 environmental command, and uses data from Medical Professional Technical Suicide Reviews (MPTSR) to examine the prevalence of other suicide risk factors for suicide deaths that occurred in 2019.

Results: Between 1995 and 2019, 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 male suicide rates in the Canadian General Population (CGP) for each time period that was evaluated.

Rate ratios comparing Regular Force males with a history of deployment to those without this history did not establish a statistically significant link between deployment and increased suicide risk. The most recent findings (2015 – 2019) suggest that the suicide rate in those with a history of deployment was slightly higher but not statistically different when compared to those with no history of deployment (age-standardized suicide rate ratio: 1.13 [95% CI: 0.59, 2.16]). This is concordant with the 10-year (2005 – 2014) pattern which indicated that those with a history of deployment were possibly at a higher risk of suicide than those with no such history (age-adjusted suicide rate ratio: 1.46 [95% CI: 0.98, 2.18]).

These rate ratios also highlighted that, since 2006 and up to and including 2019, being part of the Army command was associated with a higher risk of suicide relative to those who were part of the other environmental commands (age-standardized suicide rate ratio: 2.13 [95% CI: 1.62, 2.79]). The 3-year suicide rate moving average suggested that the gap between Army and non-Army command suicide rates appears to be narrowing. Regular Force males in the Army combat arms occupations had a statistically significant higher suicide rate (31.51/100,000 [95% CI: 25.18, 39.36]) compared to Regular Force males in other occupations (18.20/100,000 [95% CI: 15.31, 21.62]).

Results from the 2019 MPTSRs continue to support a multifactorial causal pathway (this includes biological, psychological, interpersonal, and socio-economic factors) for suicide rather than a direct link between single risk factors (such as Post-Traumatic Stress Disorder (PTSD) or deployment) and suicide. This was consistent with MPTSR findings from previous years.

Conclusions: Suicide rates in the CAF did not increase with any statistical significance over the period of observation described in these findings, and after age standardization they were also not statistically higher than those in the Canadian general population. However, small numbers do limit the ability, or power, of statistical assessments to detect statistical significance. The increased risk in Regular Force males under Army command compared to those under non-Army commands is a finding that continues to be under observation by the CAF.