Trends in suicidal behaviour and use of mental health services in Canadian military and civilian populations

Background:In the context of the Canadian mission in Afghanistan, substantial media attention has been placed on mental health and lack of access to treatment among Canadian Forces personnel. We compared trends in the prevalence of suicidal behaviour and the use of mental health services between Canadian military personnel and the general population from 2002 to 2012/13.Methods:We obtained data for respondents aged 18–60 years who participated in 4 nationally representative surveys by Statistics Canada designed to permit comparisons between populations and trends over time. Surveys of the general population were conducted in 2002 (n = 25 643) and 2012 (n = 15 981); those of military personnel were conducted in 2002 (n = 5153) and 2013 (n = 6700). We assessed the lifetime and past-year prevalence of suicidal ideation, plans and attempts, as well as use of mental health services.Results:In 2012/13, but not in 2002, military personnel had significantly higher odds of both lifetime and past-year suicidal ideation than the civilian population (lifetime: adjusted odds ratio OR] 1.32, 95% confidence interval CI] 1.17–1.50; past year: adjusted OR 1.34, 95% CI 1.09–1.66). The same was true for suicidal plans (lifetime: adjusted OR 1.64, 95% CI 1.35–1.99; past year: adjusted OR 1.66, 95% CI 1.18–2.33). Among respondents who reported past-year suicidal ideation, those in the military had a significantly higher past-year utilization rate of mental health services than those in the civilian population in both 2002 (adjusted OR 2.02, 95% CI 1.31–3.13) and 2012/13 (adjusted OR 3.14, 95% CI 1.86–5.28).Interpretation:Canadian Forces personnel had a higher prevalence of suicidal ideation and plans in 2012/13 and a higher use of mental health services in 2002 and 2012/13 than the civilian population.Suicide is a leading cause of death around the world in military and civilian populations. ^1–3 There has been increased attention paid to suicidal behaviour in Canada, and a number of initiatives are being put in place to prevent suicide through better recognition and treatment of mental disorders.⁴ Examples of major Canadian initiatives include creation of a national Mental Health Commission of Canada,⁵ development of a federal framework for suicide prevention,⁶ large investments in military and veteran mental health services, and targeted efforts to formulate comprehensive suicide prevention strategies among military and veteran populations.^4,7 Despite these initiatives, the prevalence of suicide in Canada has not changed appreciably in recent years.^8,9A recent report on suicides in the Canadian Forces did not find an overall increase in the prevalence of suicide between 1995 and 2014.¹⁰ However, the prevalence increased substantially over that time in the subgroup of male army personnel in the Regular Force.¹⁰ In the United States, the army has observed steady increases in the prevalence of suicide attempts and completed suicide by soldiers since 2004, whereas the prevalence of suicide has remained unchanged in the general population.^3,11,12 Findings from the US are not generalizable to the Canadian military because of differences in recruitment, deployment policies and health care systems.¹³Suicidal ideation, plans and attempts are strong risk factors for death by suicide.¹⁴ A history of suicide attempt is the strongest predictor of future attempts.¹⁵ Suicidal ideation is also an important target for intervention because previous work has shown a rapid transition from first-onset suicidal ideation to plans and attempts within the same year.¹⁶ It remains unknown whether nonfatal suicidal behaviour in military and civilian populations in Canada has changed over time.Another area of major public health concern is that most people with suicidal behaviour do not receive mental health services. In nationally representative civilian samples in Canada and 21 other countries, most respondents with suicidal behaviours (60%) did not receive mental health services. ^17,18 The use of such services among Canadian military personnel with suicidal behaviours remains unknown. The media has recently been critical of the Canadian Armed Forces and Veterans Affairs Canada about insufficient services available to military personnel and veterans.¹⁹We compared trends in the prevalence of suicidal behaviours and help-seeking between Canadian civilian and military populations over a 10-year period from 2002 to 2012/13 using data from 4 nationally representative surveys.