(CNN) — The risk of suicide among male U.S. veterans is double that of the general population, according to a study published Monday.
“We need to be more alert to the problem of suicide as a major public health issue and we need to do better screening among individuals who have served in the military, probe for their mental health risk as well as gun availability,” said Dr. Mark S. Kaplan, professor of community health at Portland State University in Oregon, lead author of the study in the Journal of Epidemiology and Community Health.
For 12 years, Kaplan and his team of researchers followed more than 104,000 veterans who had served in the armed forces at some time between 1917 and 1994 and compared them with more than 216,000 non-veterans.
In all, between 1986 and 1997, 508 of them committed suicide — 197 veterans and 311 non-veterans.
After adjusting for a host of potentially compounding factors, including age, time of service and health status, the study showed that those who had been in the military were 2.13 times more likely to die of suicide over time.
At biggest risk were veterans who were white, those who had gone to college and those with activity limitations, according to the study, which was funded by the National Institute of Mental Health.
‘Life is too complex’
Still, Kaplan would not say that the study proves that military service itself results in an increased risk of suicide. “I never feel comfortable claiming a causal relationship,” he said. “Life is too complex.”
No surprise was the finding that veterans were more likely to use guns to end their lives than were their non-veteran counterparts.
One unanticipated finding was that being overweight appeared to confer protection from suicide by more than 50 percent, the study found.
Kaplan cited a paucity of data on the subject, but said it might have to do with the fact that people who are underweight are more likely to smoke, and smokers are more likely to be depressed.
Though the study did not include veterans who served in Iraq and Afghanistan, “We can say quite confidently that, regardless of the era when they served, that veterans’ status alone seems to be a risk factor for suicide,” he told CNN.
“With the projected rise in functional impairments and psychiatric morbidity among veterans of the conflicts in Afghanistan and Iraq, clinical and community interventions directed towards patients in both VA and non-VA health care facilities are needed,” the authors concluded.
Kaplan said officials in the Veterans Administration were surprised by the findings, but welcomed them, “because it does point to a problem that they need to be addressing.”
The VA has recently begun expanding its mental health screening facilities, but that may not solve the problem, said Kaplan, because three-fourths of veterans do not receive their care from VA hospitals. “Our concern is that that only touches a fraction of all veterans; that most of the veterans are not being perhaps properly screened outside the VA facilities.”
About 1.3 percent of deaths in the country are estimated to be suicides, Kaplan said. But the true rate may be off by 25 percent, given that suicide has long been shrouded in stigma.
“Health care facilities don’t like to talk about suicide,” he said. “It’s often viewed as a failure of the system. … Many physicians feel, if you even mention suicide, that might prompt the behavior.”