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Background

In 2014 the Australian Department of Veterans’ Affairs (DVA) and Australian Institute of Health and Welfare (AIHW) established a partnership to build a comprehensive profile of the health and welfare of Australia’s veteran population. AIHW has worked with the Department of Defence (Defence) to link information from Defence personnel systems to a variety of health and welfare data to better understand the veteran population. This includes analyses on cause of death, use of health services and pharmaceuticals, and use of homelessness services. In 2017, the Australian Government responded to the Senate Inquiry Report, The Constant Battle: Suicide by Veterans by committing to provide an annual update on the levels of suicide among permanent, reserve, and ex-serving ADF members. In addition, recent government strategic priorities have highlighted improvements to data and evidence-based research as being essential enablers of effective suicide prevention, with all agencies and levels of government having a role to play (National Suicide Prevention Adviser 2020). This report is the fifth annual update reporting the levels of suicide among ADF members.

The first three reports included ADF members who served from 2001 based on the availability of information at that time from the Defence Personnel Management Key Solution (PMKeyS), which was launched on 1 January 2001. For the fourth report, published in 2021, DVA commissioned AIHW to investigate the feasibility of using data from earlier Defence personnel systems to build a more comprehensive picture of the ex-serving population. The Department of Defence supported this research by compiling records from historical systems. After extensive investigation and validation of data sources a population study cohort based on all ADF members with at least one day of service since 1 January 1985 was established and included for analysis. More information about this process is contained in the Technical notes.

AIHW acknowledges that the data presented in this report represent human lives and we acknowledge all of those serving and ex-serving ADF members who have died by suicide. We also acknowledge all of those who have been affected by suicide. We are committed to ensuring our work continues to inform improvements in mental health, and suicide awareness and prevention.

What is included in this report?

This report includes information on suicide deaths among ADF members who have served at least one day since 1 January 1985 and have died by suicide between 1 January 1997 and 31 December 2020.

In this report, the term ‘ADF members’ collectively refers to the three categories of ‘currently serving permanent’, ‘currently serving reserves’, and ‘ex-serving’ members (Box 1). These three ADF service status groups will be referred to as permanent, reserve, and ex-serving for the remainder of this report.

As of 31 December 2020, almost 379,000 Australians had served at least one day in the ADF between 1 January 1985 and 31 December 2020. Of these, approximately 362,000 were alive, comprising 60,000 permanent, 39,000 reserve, and 263,000 ex-serving members.

Last year’s report was based on ADF members with at least one day of service since 1 January 1985 who died by suicide between 1 January 2001 and 31 December 2019. The current report uses the same ADF cohort (plus the 2020 data) and expands the suicide monitoring period to 1 January 1997 to 31 December 2020. This extended period permits the analysis of earlier suicide deaths and more ADF subpopulations at risk of suicide. Care should be taken in directly comparing data in this report with previous AIHW publications due to the wider monitoring period.

Information in this report is presented by service status, age, sex, service, rank, length of service, time since separation and reason for separation. These factors were assessed independently to determine rates of death by suicide as well as concurrently using multi-factor survival modelling analysis1.

This year’s report includes a special ‘in-focus’ section, which presents information on risk factors for ADF members who died by suicide, including biological, psychological and psychosocial risk factors. Risk factors were captured in causes of death coding conducted by the Australian Bureau of Statistics (ABS) both as part of routine coding and as commissioned by the AIHW for this project. The analysis acknowledges that suicide is affected by a complex interaction of factors over the course of an individual’s lifetime. Understanding these risk factors can inform approaches to suicide prevention.

The ‘in-focus’ section includes information on risk factors and service-related characteristics among ADF members who have served at least one day since 1 January 1985 in relation to deaths by suicide between 1 January 2001 and 31 December 2020. Analysis of risk factors among people who died by suicides in the Australian population are presented to understand whether ADF members have different risk factors for suicide compared with the general Australian population.

It should be noted that the female ADF cohort is smaller than the male cohort and, in general, suicide rates for females in the Australian population are low. The Confidence Intervals (CIs) for statistics relating to female ADF members in this report are wide, meaning that there is less certainty in the accuracy of the statistic. This affects our ability to detect statistically significant differences between the female ADF cohort and Australian females overall. As a result, caution should be taken in interpreting these data. 

Box 1: Who is included in this report?

Permanent: ADF members serving in a full-time capacity in the Royal Australian Navy (Navy), Australian Army (Army) or the Royal Australian Air Force (Air Force) on or after 1 January 1985, and serving in a permanent capacity on 31 December 2020 or on the date they died.

Reserve: ADF members who were in the reserve forces for the Navy, Army, or the Air Force on or after 1 January 1985, and were in the reserve forces on 31 December 2020 or when they died. Many members leaving full-time service transition to the reserves for a minimum of five years. The service status ‘reserve’ includes members with a wide range of relationships to the ADF. For example, it includes personnel who have transitioned from full time service as well as both those who joined and have served solely in reserve capacity. Some reserve members may serve with enduring regular employment (active reserves), while others may not render service in any capacity (standby reserves)2.  

Ex-serving: ADF members who were in the permanent or reserve services between 1 January 1985 and 31 December 2020, who subsequently transitioned from Defence.

Each release updates previously published numbers of suicides to reflect updates to the source data. The main reasons for changes to previously published results are:

  • Use of an expanded monitoring period, in this case deaths by suicide from 1997 to 2020 (previously this period was 2001 to 2019) for those who served at least one day from 1 January 1985 are included.
  • A lag in cause of death information for more recent years of data, where cause of death is finalised in the following years.
  • Revisions to cause of death data by the Australian Bureau of Statistics (ABS).
  • Improvements in information available to the study.

More detail on these reasons for changes to previously published information is provided in the Technical notes.

What is not included in this report?

This report does not include data on several areas that may be of relevance to a study of suicide in the ADF member population and would benefit from further exploration. For example, data are not included on living members who have experiences with suicide ideation, attempted suicide, or intentional self-harm, as this report only presents information on confirmed deaths by suicide. Deaths that lack sufficient evidence to make a ruling of suicidal intent (such that they are unable to be classified as a confirmed suicide) are also not included.

Further investigations with experts on the Defence HR personnel datasets are underway to investigate the possibility of analysing the impact of deployment, including type of deployments and occupations while on deployment. Obtaining further information on ADF members who separated involuntarily for medical reasons is also under investigation, to gain a better understanding of how this may affect deaths by suicide among this group.

Consideration is also being given to comparing subpopulations within the ADF cohort with more appropriate alternative populations. For instance, comparing people who separate from the ADF for medical reasons with people who have similar medical conditions in the general Australian population.

For some of the proposed analyses more time is needed. For others, no data are readily available, and these will require data development or linkage before information can be reported.

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Notes on measuring death by suicide

Information on suicide is presented in 4 ways in this report.

  1. Overall counts of suicides are presented to give an indication of the total scale.
  2. Suicide rates are reported to compare across groups within the permanent, reserve, and ex-serving cohorts, to take into account the size of the underlying population.
  3. Age-adjusted suicide rates and Standardised Mortality Ratios (SMRs) are used to compare rates of suicide between groups with different age structures, such as when comparing the permanent, reserve, and ex-serving populations with the general Australian population.
  4. Hazard ratios (HRs) are used in survival modelling to compare the hazard or likelihood of suicide between groups within the model.

Confidence Intervals of 95% are used to assess uncertainty in suicide rates. CIs give some indication of how close the true rate lies to the calculated rate. Narrower CIs indicate more certainty in the result, and wider intervals means less certainty in the result.

More information on these concepts is in the Technical notes.

Box 2: The ADF population with at least one day of service since 1 January 1985 and how it compares with the Australian population

As of 31 December 2020, almost 379,000 Australians had served at least one day in the ADF between 1 January 1985 and 31 December 2020. Of these, approximately 362,000 were still alive, comprising 60,000 permanent, 39,000 reserve, and 263,000 ex-serving members.

Since 1985 the ex-serving population with at least one day of service since 1 January 1985 has increased each year as permanent and reserve ADF members separate. At the end of 1985, 6,100 members of this cohort had separated and by the end of 2020 this had grown to 277,000 (of whom 260,000 are still alive). As members leave the permanent and reserve service they are counted as members of the ex-serving study population until they die.

The permanent, reserve, and ex-serving populations have different demographics to the Australian population overall. While the Australian population is 50% male, the ADF population is 85% male. The serving ADF population is on average younger than the Australian population.

These age and sex differences are considered when examining differences in suicide levels between these populations.

See the AIHW report Serving and ex-serving Australian Defence Force members who have served since 1985: population characteristics 2019 for more detail on the ADF population characteristics.

 

  1. Survival modelling analysis here is a generic term for statistical methods used to describe the time it takes for an event to occur after some intervention, termed survival time.
  2. There was no statistically significant difference in suicide rates between the active and standby reserves. See the Technical notes for more details.
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