Sex differences in suicide mortality among Vietnam War-era veterans 1979-2019: a cohort study

Suicide mortality among Vietnam War-era veterans has been examined for nearly five decades. Research on sex-based differences in postwar suicide risk among this veteran cohort, however, remains scant.

To examine the association of theatre deployment or deployment to Vietnam or the surrounding theatres of war operations between 1961 and 1975, and sex differences in risk of postwar (1979-2019) suicide mortality among Vietnam War-era veterans.

This was an observational study using a retrospective cohort design to examine the impact of sex and theatre deployment or deployment to Vietnam or the surrounding theatres of war operations between 1961 and 1975 on risk of postwar suicide mortality among 9 494 656 US Vietnam War-era veterans. Suicide mortality data were drawn from the Veterans Affairs Mortality Data Repository, 1979-2019.

A total of 94 497 suicide deaths were observed. Theatre deployment was not associated with increased risk of suicide among male, HR 0.94 (95% CI 0.93 to 0.96), or female, HR 1.22 (95% CI 0.94 to 1.59), veterans. Relative to the general population, female veterans had heightened risk of suicide, standardised mortality ratios (SMR) 1.75 (95% CI 1.66 to 1.86); male veterans did not, SMR 0.97 (95% CI 0.97 to 0.98). Firearms were used in 45% of all observed suicides.

Theatre deployment was not associated with increased risk of suicide. Female veterans' elevated risk of suicide relative to the general population, however, warrants attention.

Vigilant attention to the heightened risk of suicide among female Vietnam War-era veterans relative to the general population is needed.