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Research

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

Jitender Sareen, Tracie O. Afifi, Tamara Taillieu, Kristene Cheung, Sarah Turner, Shay-Lee Bolton, Julie Erickson, Murray B. Stein, Deniz Fikretoglu and Mark A. Zamorski
CMAJ August 09, 2016 188 (11) E261-E267; DOI: https://doi.org/10.1503/cmaj.151047
Jitender Sareen
Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
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  • For correspondence: sareen@cc.umanitoba.ca
Tracie O. Afifi
Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
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Tamara Taillieu
Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
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Kristene Cheung
Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
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Sarah Turner
Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
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Shay-Lee Bolton
Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
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Julie Erickson
Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
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Murray B. Stein
Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
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Deniz Fikretoglu
Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
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Mark A. Zamorski
Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
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Article Figures & Tables

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    Table 1:

    Lifetime prevalence of suicidal behaviour among Canadian military personnel and civilians, 2002–2012/13

    Suicidal behaviorMilitary personnelCivilian populationMilitary v. civilian
    Prevalence, % (95% CI)Adjusted OR† (95% CI), 2013 v. 2002Prevalence, % (95% CI)Adjusted OR† (95% CI), 2012 v. 2002Adjusted OR† (95% CI), 2002Adjusted OR† (95% CI), 2012/13
    2002 n = 51532013*n = 67002002 n = 25 6432012 n = 15 981
    All
    Ideation15.7 (14.7–16.9)15.4 (14.5–16.3)1.04 (0.93–1.17)15.2 (14.6–15.8)13.3 (12.5–14.1)0.93 (0.85–1.02)1.09 (0.98–1.22)1.32 (1.17–1.50)
    PlanNA6.1 (5.5–6.7)NANA4.6 (4.1–5.1)NANA1.64 (1.35–1.99)
    Attempt2.5 (2.1–3.1)3.0 (2.5–3.5)1.32 (1.02–1.72)3.6 (3.3–3.9)3.5 (3.1–4.0)1.10 (0.93–1.30)0.92 (0.74–1.15)1.14 (0.91–1.44)
    Men
    Ideation14.8 (13.6–16.0)14.9 (13.9–15.9)1.11 (0.97–1.26)14.0 (13.2–14.9)11.8 (10.7–12.9)0.88 (0.77–1.00)1.03 (0.91–1.18)1.30 (1.12–1.52)
    PlanNA5.9 (5.3–6.6)NANA4.0 (3.5–4.7)NANA1.66 (1.33–2.08)
    Attempt2.1 (1.6–2.7)2.6 (2.1–3.1)1.51 (1.09–2.09)2.4 (2.1–2.7)2.7 (2.2–3.2)1.23 (0.98–1.54)0.83 (0.62–1.11)1.15 (0.85–1.55)
    Women
    Ideation22.6 (20.5–24.9)18.4 (15.7–21.3)0.78 (0.62–0.97)16.3 (15.4–17.2)14.8 (13.6–16.1)0.98 (0.87–1.11)1.48 (1.27–1.74)1.36 (1.09–1.70)
    PlanNA6.7 (5.2–9.1)NANA5.1 (4.3–6.0)NANA1.60 (1.09–2.35)
    Attempt5.8 (4.7–7.0)5.4 (3.9–7.5)0.92 (0.59–1.44)4.8 (4.4–5.3)4.4 (3.7–5.2)1.03 (0.82–1.29)1.22 (0.93–1.61)1.42 (0.93–2.18)
    • Note: CI = confidence interval, NA = not available in data set or not released by Statistics Canada to protect respondents’ confidentiality, OR = odds ratio.

    • ↵* In the Canadian Forces 2013 survey, percentages were based on weighted numbers, which were rounded to a base 20 for confidentiality purposes according to Statistics Canada’s data-release policies.

    • ↵† Adjusted for age, sex, marital status, visible minority status, education and income.

    • View popup
    Table 2:

    Past-year prevalence of suicidal behaviour among Canadian military personnel and civilians, 2002–2012/13

    Suicidal behaviorMilitary personnelCivilian populationMilitary v. civilian
    Prevalence, % (95% CI)Adjusted OR† (95% CI), 2013 v. 2002Prevalence, % (95% CI)Adjusted OR† (95% CI), 2012 v. 2002Adjusted OR† (95% CI), 2002Adjusted OR† (95% CI), 2012/13
    2002 n = 51532013*n = 67002002 n = 25 6432012 n = 15 981
    All
    Ideation4.2 (3.7–4.8)4.3 (3.7–4.9)1.13 (0.91–1.40)3.9 (3.6–4.3)3.6 (3.2–4.1)1.00 (0.84–1.19)1.11 (0.92–1.33)1.34 (1.09–1.66)
    PlanNA1.8 (1.5–2.1)NANA1.3 (1.0–1.7)NANA1.66 (1.18–2.33)
    Attempt0.3 (0.2–0.5)0.4 (0.2–0.6)1.33 (0.61–2.87)0.6 (0.5, 0.7)0.6 (0.4–0.9)1.29 (0.78–2.14)0.61 (0.34–1.08)0.88 (0.43–1.77)
    Men
    Ideation4.0 (3.4–4.7)4.3 (3.7–4.9)1.17 (0.92–1.49)4.0 (3.5–4.5)3.4 (2.9–4.0)0.90 (0.71–1.16)1.11 (0.90–1.38)1.43 (1.10–1.86)
    PlanNA1.8 (1.5–2.2)NANA1.3 (0.9–1.7)NANA1.84 (1.22–2.77)
    Attempt0.2 (0.1–0.4)NANA0.5 (0.3–0.6)0.5 (0.3–0.7)1.11 (0.62–2.02)0.42 (0.15–1.18)NA
    Women
    Ideation5.3 (4.3–6.5)4.3 (2.9–6.0)0.93 (0.55–1.56)3.9 (3.4–4.4)3.9 (3.2–4.5)1.09 (0.86–1.39)1.41 (1.07–1.85)1.17 (0.75–1.83)
    PlanNA1.6 (0.8–2.8)NANA1.3 (0.9–2.0)NANA1.23 (0.55–2.76)
    Attempt1.1 (0.7–1.8)NANA0.7 (0.5–0.9)0.7 (0.4–1.3)1.40 (0.67–2.89)1.69 (0.85–3.36)NA
    • Note: CI = confidence interval, NA = not available in data set or not released by Statistics Canada to protect respondents’ confidentiality, OR = odds ratio.

    • ↵* In the Canadian Forces 2013 survey, percentages were based on weighted numbers, which were rounded to a base 20 for confidentiality purposes according to Statistics Canada’s data-release policies.

    • ↵† Adjusted for age, sex, marital status, visible minority status, education and income.

    • View popup
    Table 3:

    Prevalence of past-year help-seeking among Canadian military and civilians who reported past-year suicidal behaviours

    Sector of treatment; reported behaviourMilitary personnelCivilian populationMilitary v. civilian
    Prevalence, % (95% CI)Adjusted OR† (95% CI), 2013 v. 2002Prevalence, % (95% CI)Adjusted OR† (95% CI), 2012 v. 2002Adjusted OR† (95% CI), 2002Adjusted OR† (95% CI), 2012/13
    20022013*20022012
    Psychiatrist
    Ideation24.6 (18.6–31.8)38.7 (32.3–45.4)2.32 (1.42–3.77)17.3 (14.5–20.5)20.9 (16.9–25.6)1.45 (1.00–2.09)1.73 (1.03–2.92)2.41 (1.39–4.17)
    PlanNA45.6 (36.3–56.9)NANA35.7 (25.3–47.7)NANA1.18 (0.41–3.46)
    Attempt47.2 (26.6–68.9)50.0 (28.9–74.4)1.32 (0.11–16.11)37.6 (28.1–48.2)30.1 (16.7–47.9)0.73 (0.31–1.72)1.64 (0.49–5.45)3.93 (0.84–18.39)
    Psychologist
    Ideation25.4 (19.4–32.6)40.9 (34.4–47.6)2.17 (1.35–3.48)12.0 (9.5–15.2)17.5 (12.6–23.9)1.49 (0.95–2.35)2.42 (1.26–4.65)4.67 (2.58–8.47)
    PlanNA50.9 (40.1–61.2)NANA28.2 (16.8–43.2)NANA3.88 (0.94–16.04)
    Attempt48.3 (27.2–70.1)50.0 (29.3–72.3)0.94 (0.15–5.74)17.4 (9.9–28.6)32.0 (14.0–57.6)2.37 (0.55–10.23)4.58 (1.15–18.15)6.33 (0.65–61.56)
    Family physician
    Ideation36.0 (29.2–43.4)43.8 (36.8–50.6)1.48 (0.94–2.34)31.2 (27.1–35.6)40.0 (33.4–46.9)1.53 (1.09–2.15)1.94 (1.23–3.05)1.71 (1.02–2.84)
    PlanNA49.1 (39.8–59.9)NANA57.4 (45.0–68.9)NANA1.01 (0.33–3.08)
    Attempt60.7 (37.6–79.8)58.3 (35.2–77.1)1.18 (0.14–10.14)41.2 (31.3–51.8)70.8 (53.9–83.4)3.55 (1.45–8.69)2.68 (0.69–10.38)0.55 (0.13–2.39)
    Nurse
    Ideation14.9 (10.2–21.2)29.2 (23.6–35.0)2.84 (1.59–5.09)4.4 (3.1–6.1)7.5 (5.3–10.5)1.77 (1.03–3.06)7.51 (3.13–18.06)6.54 (3.00–14.28)
    PlanNA40.4 (31.5, 50.8)NANA10.8 (6.4–17.6)NANA8.53 (1.95–37.25)
    Attempt35.0 (17.5–57.8)58.3 (33.6–76.9)2.48 (0.33–18.98)12.2 (7.0–20.5)11.0 (5.4–21.3)0.93 (0.35–2.47)5.26 (1.31–21.15)23.40 (1.86–294.48)
    Social worker
    Ideation25.4 (19.1–33.0)52.6 (45.8–58.7)3.76 (2.29–6.16)11.6 (8.6–15.5)22.5 (18.2–27.5)2.43 (1.54–3.86)4.17 (2.20–7.91)4.84 (2.83–8.27)
    PlanNA54.4 (43.8–64.0)NANA29.0 (20.5–39.3)NANA4.23 (1.39–12.85)
    Attempt39.5 (20.6–62.2)NANA17.1 (11.2–25.2)30.6 (17.6–47.7)2.19 (0.78–6.17)3.60 (1.08–12.02)NA
    Any treatment seeking
    Ideation51.3 (44.0–58.6)73.0 (66.6–78.6)3.16 (1.96–5.08)42.1 (37.6–46.8)57.0 (50.8–63.0)1.90 (1.37–2.62)2.02 (1.31–3.13)3.14 (1.86–5.28)
    PlanNA77.2 (68.1–85.7)NANA75.7 (66.0–83.3)NANA1.84 (0.61–5.53)
    Attempt72.0 (47.5–87.9)NANA58.4 (46.8–69.1)79.8 (65.0–89.4)2.83 (1.13–7.11)2.00 (0.49–8.22)NA
    No. of professionals‡Mean no. (95% CI)χ2Mean no. (95% CI)χ2χ2χ2
    20022013*20022012
    Ideation1.5 (1.2–1.8)2.6 (2.1–3.0)21.460.7 (0.6–0.8)1.1 (1.0–1.2)19.7318.5334.65
    PlanNA2.5 (1.8–3.3)NANA1.6 (1.3–1.9)NANA4.87
    Attempt2.5 (1.4–3.5)3.5 (2.5–4.5)2.131.2 (0.9–1.5)1.7 (1.4–2.1)7.025.1210.99
    • Note: CI = confidence interval, NA = not available in data set or not released by Statistics Canada to protect respondents’ confidentiality, OR = odds ratio.

    • ↵* In the Canadian Forces 2013 survey, percentages were based on weighted numbers, which were rounded to a base 20 for confidentiality purposes according to Statistics Canada’s data-release policies.

    • ↵† Suicide ideation and suicide plan models adjusted for age, sex, marital status, visible minority status, education and income; suicide attempt models adjusted for age and sex.

    • ↵‡ Estimated marginal means (i.e., adjusted means) were computed from coefficients derived from negative binomial regression models. Models were adjusted for variables as described above.

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Trends in suicidal behaviour and use of mental health services in Canadian military and civilian populations
Jitender Sareen, Tracie O. Afifi, Tamara Taillieu, Kristene Cheung, Sarah Turner, Shay-Lee Bolton, Julie Erickson, Murray B. Stein, Deniz Fikretoglu, Mark A. Zamorski
CMAJ Aug 2016, 188 (11) E261-E267; DOI: 10.1503/cmaj.151047

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Trends in suicidal behaviour and use of mental health services in Canadian military and civilian populations
Jitender Sareen, Tracie O. Afifi, Tamara Taillieu, Kristene Cheung, Sarah Turner, Shay-Lee Bolton, Julie Erickson, Murray B. Stein, Deniz Fikretoglu, Mark A. Zamorski
CMAJ Aug 2016, 188 (11) E261-E267; DOI: 10.1503/cmaj.151047
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