Reevaluating Suicide Mortality for Veterans With Data From the VA-DoD Mortality Data Repository, 2000-2010

Abstract

Objective: The Department of Veterans Affairs and Department of Defense Mortality Data Repository (MDR) compiles National Death Index records for all veterans and military service members. This study aimed to compare MDR findings with those from a preexisting data source.

Methods: Veteran suicide rates estimated from death certificates were replicated with the MDR. Annual suicide rates were computed for veterans overall, by gender, and by Veterans Health Administration service utilization and compared with rates for adult nonveterans by using standardized mortality ratios (SMRs).

Results: Suicide rates and SMRs differed between the data sources. The 2010 MDR-derived veteran suicide rate was 27.4 deaths per 100,000 veterans, compared with an earlier estimate of 35.9. Differences were greater for females. Divergence was attributed to improved accuracy identifying veteran suicide decedents in the MDR.

Conclusions: Conditions with low base rates can be major public health problems, and minor misclassification can substantially affect surveillance accuracy, prevention efforts, and the validity of study findings.

Keywords: Suicide; surveillance; veterans issues.

FIGURE 1.

Suicide rates and standardized mortality ratios among veterans, by gender and VHA utilization, 2000–2010^{a a} Source: joint U.S. Department of Veterans Affairs and U.S. Department of Defense Mortality Data Repository. A: direct age-adjusted suicide rates (per 100,000 lives) for adult veterans, overall and by gender. B: standardized suicide mortality ratios for veterans compared with nonveterans, overall and by Veterans Health Administration (VHA) service utilization status. C: standardized suicide mortality ratios for veterans who used VHA services in the year prior to death compared with veterans who did not, overall and by gender.