Introduction

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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 Australian Defence Force (ADF) members. The Royal Commission into Defence and Veteran Suicide, conducted between 2021 to 2024, inquired into the systemic issues and risk factors relevant to suicide and suicide behaviours of serving and ex-serving Defence members. This AIHW report is the seventh annual update reporting the levels of suicide among ADF members.

The first 3 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 subsequent analyses. 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, including their families. 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 2022.

In this report, the term ‘ADF members’ collectively refers to the 3 categories of: ‘currently serving permanent’, ‘currently serving active and standby reserves’, and ‘ex-serving’ members (see Box 1). These 3 ADF service status groups will be referred to as permanent, reserve, and ex-serving for the remainder of this report.

As of 31 December 2022, around 392,000 Australians had served at least one day in the ADF between 1 January 1985 and 31 December 2022. Of these, approximately 373,000 were alive, comprising 58,800 permanent, 39,800 reserve, and 274,000 ex-serving members. Box 2 below gives more information on the ADF population used in this report and how it compares to the Australian population.

Routine monitoring in this series of annual reports is presented by service status, age, sex, service, rank, length of service, time since separation and reason for separation. New additions featured in this monitoring report include:

  • an introductory section reporting the leading causes of death among ADF members.
  • analysis of the involuntary separation reason of Retention not in service interest.
  • analysis of the additional variables year of hire, year of separation, and basic training completion status
  • multi-factor survival modelling analysis.

Other service-related factors that were investigated include operational experience, proficiencies for the training course Conduct after capture1, unit, location and occupation. However, these have been excluded from the main report due to data limitations, small population sizes, and high frequency of movement by personnel. Further details with some preliminary findings are in the Technical notes.

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 2022 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 2022 or when they died. Many members leaving full-time service transition to the reserves for a minimum of 5 years. The service status ‘reserve’ includes members with a wide range of relationships to the ADF. 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).
  • Ex-serving: ADF members who were in the permanent or reserve services between 1 January 1985 and 31 December 2022 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:

  • Updating the data to include the most recent year’s population and deaths.
  • A lag in cause of death information for more recent years of data, where cause of death is finalised in 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.

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 2022, around 392,000 Australians had served at least one day in the ADF between 1 January 1985 and 31 December 2022. Of these, approximately 373,000 were still alive, comprising 58,800 permanent, 39,800 reserve, and 274,000 ex-serving members.

Since 1985, the ex-serving population with at least one day of service has increased each year as permanent and reserve ADF members separate. At the end of 1985, there were 6,100 ex-serving members and by the end of 2022 this had grown to 290,000 (of whom 274,000 are still alive). As members leave the permanent and reserve service they are counted as members of the ex-serving study population.

The permanent, reserve, and ex-serving populations have different demographics to the Australian population overall. For example, the Australian population is 50% male, the ADF population is 84% male. The median age for permanent, reserve and ex-serving members are 31, 37 and 52 years respectively, compared with 46 years for the Australian population over 17 years of age.

Age and sex demographic factors are considered when examining differences in suicide levels between the ADF and Australian 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.

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 could further build the evidence base. For example, data are not included on living ADF members who have experiences with suicidal ideation, attempted suicide, or intentional self-harm.

More detailed information on ADF members who separated involuntarily for medical reasons, including detail on related medical conditions, could enable a better understanding of how separating for medical reasons may affect suicide deaths for this cohort. Developing a better matched comparator cohort of other Australians with similar medical conditions may also help to improve our understanding of suicide by ADF members who separated involuntarily for medical reasons.

For some of the above areas of study there are currently no readily available complete data sources for analysis. Further investigations continue in these areas where for example, new insights for living ADF members who have experiences with suicidal ideation, attempted suicide, or intentional self-harm, have been reported by using admitted patient and emergency department health services linked data assets (Characteristics of ex-serving Australian Defence Force members hospitalised for suicidality and intentional self-harm). The study of other areas by AIHW or other researchers would require data development or linkage before information could be reported.

What was featured in previous editions?

The following outlines the additional analyses featured in previous editions of the report that are not routinely reported.

The 2023 report, Serving and ex-serving Australian Defence Force members who have served since 1985: suicide monitoring 1997 to 2021, included an in-focus chapter on DVA clients. This presents information about interactions with DVA from 2002 to 2021 by ADF members who have served since 1985. The chapter provides a profile of DVA clients and deaths by suicide are reported.

The 2023 report was released in conjunction with a separate restricted-access web article further examining suicide and select causes of death among ADF members who have served since 1985. This web article is available on request from [email protected] with approval by AIHW. This is in line with Mindframe guidelines due to the potentially distressing nature of the subject matter. Please consider your need to read this article and provide the purpose of the access request.

The 2022 report, Serving and ex-serving Australian Defence Force members who have served since 1985: suicide monitoring 1997 to 2020, presents information on risk factors for ADF members who died by suicide, including biological, psychological and psychosocial risk factors. This includes ADF members who have served at least one day since 1 January 1985 who have died by suicide between 1 January 2001 and 31 December 2020.

The 2022 report also includes multi-factor survival modelling analysis which is expanded on in this current report (See Modelling suicide rates).

Notes on measuring death by suicide

Information on suicide is presented in 3 ways in this report.

  1. Overall counts of suicides are presented to give an indication of the total occurrences.
  2. Suicide rates are reported to compare across groups within the permanent, reserve, and ex-serving ADF members to take into account the size of the underlying population.
  3. 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 (CIs) 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. Generally, narrower CIs indicate more certainty in the result, and wider intervals means less certainty in the result.

Population sizes and the number of suicides among ADF females is lower compared to ADF males where suicide rates for females in the Australian population are lower than that of males 2. As such, CIs for statistics relating to female ADF members in this report are relatively wide, meaning that there is less certainty in the accuracy of the calculated values. This affects our ability to detect statistically significant differences within female ADF sub-populations. As a result, caution should be taken in interpreting these data.

More information on these concepts is in the Technical notes.

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