{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T18:10:01Z","timestamp":1756663801714,"version":"3.44.0"},"reference-count":40,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Ministry of Defence","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"NHS England","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,2,24]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Although there have been a number of epidemiological studies of suicide in veterans, there have been few in-depth studies of those who have died. Studies have not explored the relative contribution of pre-service, in-service and post-service factors. We aimed to investigate the adversities veterans face before they take their lives, their contact with support services that could be preventative and whether these differ in younger and older veterans.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using national databases of discharged personnel and suicide deaths, we identified deaths by suicide in personnel who left the UK Armed Forces (UKAF) between 2007 and 2018. We extracted information on the antecedents of suicide in a random sample of these deaths from official investigations, mostly coroners\u2019 records.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In total, we obtained data for 145 individuals; 134 (92%) were male and 11 (8%) were female. Seven (5%) were from a minority ethnic group. The median age at death was 36 years (21\u201365 years). 18 (12%) veterans had experienced childhood adversity. Relatively few (10, 7%) experienced trauma relating to deployment on combat operations or had difficulty adjusting to civilian life (6, 4%). Most (140, 97%) veterans had been in contact with support services, particularly primary care (130, 90%), but undertreatment was common with only 10 (5%) veterans having received psychological intervention. Unemployment, alcohol and drug misuse, mental and physical ill health, workplace, housing and relationship problems were common antecedents.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Veterans experience a range of challenges after leaving the UKAF. Common antecedents to suicide, such as self-harm, suicidal ideation and drug misuse, are open to intervention. However, despite most veterans seeking help from a range of support services, few were receiving psychological intervention. Prevention should also focus on addressing the needs of veterans beyond mental ill health, like employment and housing.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjph-2024-001433","type":"journal-article","created":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T02:15:24Z","timestamp":1742955324000},"page":"e001433","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Observational study of the pre-service vulnerabilities, in-service exposures and post-service antecedents of suicide in veterans of the UK Armed Forces, 2007\u20132018"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5820-0935","authenticated-orcid":false,"given":"Jodie","family":"Westhead","sequence":"first","affiliation":[{"name":"National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, Manchester, UK"},{"name":"NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saied","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lana","family":"Bojani\u0107","sequence":"additional","affiliation":[{"name":"National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pauline","family":"Turnbull","sequence":"additional","affiliation":[{"name":"National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louis","family":"Appleby","sequence":"additional","affiliation":[{"name":"National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andy","family":"Bacon","sequence":"additional","affiliation":[{"name":"Formerly of Armed Forces Team, NHS England, London, UK"},{"name":"Westminster Centre for Research in Veterans, University of Chester, Chester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harriet","family":"Dale","sequence":"additional","affiliation":[{"name":"Defence Statistics Health, Ministry of Defence, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate","family":"Harrison","sequence":"additional","affiliation":[{"name":"Defence Statistics Health, Ministry of Defence, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nav","family":"Kapur","sequence":"additional","affiliation":[{"name":"National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, Manchester, UK"},{"name":"NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK"},{"name":"Mersey Care NHS Foundation Trust, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0007-0124","authenticated-orcid":false,"given":"Cathryn","family":"Rodway","sequence":"additional","affiliation":[{"name":"National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"key":"2025083110304732000_3.1.e001433.1","unstructured":"Office for national statistics (ons) . Characteristics of uk armed forces veterans, england and wales: census 2021. ONS; 2023. Available: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/armedforcescommunity\/articles\/characteristicsofukarmedforcesveteransenglandandwalescensus2021\/census2021 [Accessed 29 Jan 2025]."},{"key":"2025083110304732000_3.1.e001433.2","unstructured":"Office of Mental Health and Suicide Prevention, 2022. Available: https:\/\/www.mentalhealth.va.gov\/suicide_prevention\/data.asp [Accessed 6 Mar 2024]."},{"key":"2025083110304732000_3.1.e001433.3","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.annepidem.2014.11.020","article-title":"Suicide risk among 1.3 million veterans who were on active duty during the Iraq and Afghanistan wars","volume":"25","author":"Kang","year":"2015","journal-title":"Ann Epidemiol"},{"key":"2025083110304732000_3.1.e001433.4","doi-asserted-by":"crossref","first-page":"S131","DOI":"10.2105\/AJPH.2011.300445","article-title":"Suicide risk and precipitating circumstances among young, middle-aged, and older male veterans","volume":"102 Suppl 1","author":"Kaplan","year":"2012","journal-title":"Am J Public Health"},{"key":"2025083110304732000_3.1.e001433.5","unstructured":"Simkus K , Hall A , Heber A , et al . Veteran suicide mortality study: follow\u2013up period from 1976 to 2014. Veterans Affairs Canada; 2019. 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Suicide mortality among deployed male military personnel compared with men who were not deployed. RIVM; 2015. Available: https:\/\/www.rivm.nl\/bibliotheek\/rapporten\/2015-0155.pdf [accessed 6 Mar 2024]"},{"key":"2025083110304732000_3.1.e001433.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-014034","article-title":"Suicide and all-cause mortality in Swedish deployed military veterans: a population-based matched cohort study","volume":"7","author":"Pethrus","year":"2017","journal-title":"BMJ Open"},{"key":"2025083110304732000_3.1.e001433.11","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1004273","article-title":"Suicide after leaving the UK Armed Forces 1996-2018: A cohort study","volume":"20","author":"Rodway","year":"2023","journal-title":"PLoS Med"},{"key":"2025083110304732000_3.1.e001433.12","doi-asserted-by":"crossref","unstructured":"Randles R , Burroughs H , Green N , et al . Prevalence and risk factors of suicide and suicidal ideation in veterans who served in the British Armed Forces: a systematic review. 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