The Impact of Military Service and Substance Abuse on Suicidality: A Comparison Between Male Military Service Members and Civilians

Background/Purpose: The US military continues to search for answers in the battle against ever increasing suicide-related casualties. A spate of recent studies has contrasted suicide risk among military veterans with that of the non-military general population, yielding mixed and often conflicting results. Notably, however, this body of research is limited by the lack of interaction effects between substance abuse and military service in predicting suicidality. The present study aims to rectify this gap by systematically examining the interrelatedness of substance abuse and military status, and elucidating the contributions of these factors to the problem at hand. 

Methods: Data were derived from a population-based study (National Survey on Drug Use and Health, 2013 [NSDUH]) of the civilian, non-institutionalized population ages 12 years and older in the United States (N = 55,160). Military status was determined by asking respondents: “Are you currently on active duty in the armed forces, in a reserve component, or now separated or retired from either reserves or active-duty?” Notably, any respondents reporting active-duty status were terminated from the interview per NSDUH guidelines; however, reservists and separated/retired respondents were included. Due to the relatively low proportion (< 10%) of female respondents reporting military service, we limited our sample to only male respondents who were at least 18 years old at the time of interview (n = 17,098). Suicidality was measured based on a single-item (no = 0, yes = 1): “At any time in the past 12 months, did you seriously think about trying to kill yourself?’’ Past 12-month substance abuse (0 = no, 1 = yes) was determined based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Binary logistic regression analyses were conducting using suicidality as the dependent variable with military status, substance abuse, and an interaction term of military*substance abuse as primary independent variables. All multivariate analyses were conducted while controlling for age, race/ethnicity, income, education level, marital status, and self-reported health.  

Results: Bivariate analyses indicate military status is associated with a decreased likelihood of suicidality (OR = 0.70, 95% CI = 0.55-0.90) and that past-12 month substance abuse is linked with increased risk of suicidality (OR = 1.54, 95% CI = 1.25-1.90). However, when controlling for sociodemographic factors, military status ceased to be significantly associated with suicidality and the magnitude of the relationship between substance abuse and suicidality was attenuated (AOR = 1.28, 95% CI = 1.04-1.58). Finally, controlling for sociodemographic confounds, we identified a significant interaction effect between military status and substance abuse (AOR = 2.47, 95% CI = 1.12-5.41) as related to risk for suicidality.

Conclusions and Implications: We found that those who have served in our Armed Forces do not, as a whole, seem to face greater risk of suicidality compared to the US civilian population. However, reservists and veterans with substance abuse problems seem to be at substantial elevated risk of suicidality. This suggests that future policy and practice focused on substance abuse prevention and treatment may be warranted especially helpful to former US military personnel.