Study Design






Thomas et al. 1991

Retrospective cohort, mortality

4582 female Vietnam-theater veterans, 5324 female Vietnam-era veterans; theater veterans served in Vietnam in 1965-1973

Mortality data from death certificates coded by ICD-9 and blind to Vietnam status

Cause-specific mortality rates; all causes of death combined rate ratio 0.93, 95% CI 0.74-1.16; external causes rate ratio 1.33, 95% CI 0.80-2.23; motor-vehicle accidents rate ratio 3.19, 95% CI 1.03-9.86; suicide rate ratio 0.96, 95% CI 0.39-2.39

Rank, military occupation, duration of military service, age at entry into followup, race

Small cohort of women, short followup period, small number of deaths

Bullman and Kang 1996

Retrospective cohort, average length of followup 21 years

34,534 wounded Vietnam-theater veterans selected randomly from sample of 70,000 wounded veterans included in Casualty Information System database in 1969-1973

Followup from date of wounding until death or December 31, 1991, whichever was earlier; cause of death was based on data from each veteran’s death certificate coded by ICD-9; Casualty Information System data used to measure date of wounding, severity of wound, number of times wounded

Suicide among veterans who were wounded once and not hospitalized rate ratio 1.00; wounded once and hospitalized rate ratio 1.19, 95% CI 0.85-1.66; wounded two or more times and not hospitalized rate ratio 1.24, 95% CI 0.53-2.88; wounded two or more times and hospitalized for wound rate ratio 1.82, 95% CI 1.12-2.96; compared with U.S. population, wounded veterans had slightly higher risk of death from suicide standardized mortality ratio 1.12, 95% CI 0.96-1.30


1990 data showing military population in general had lower suicide risk than U.S. population (standardized mortality ratio = 0.69, 95% CI 0.56-0.82); risk is almost twice that for peace time, supporting association between exposure to combat trauma and increased risk of suicide

Kang and Bullman 1996

Retrospective cohort, postwar mortality, 2.4-year followup

695,516 GW-deployed veterans, 746,291 nondeployed veterans, including 49,919 female GW veterans, 84,517 female active-duty controls

Vital-status followup using VA and SSA databases; mortality data from death certificates; causes of death coded by ICD-9 and blind to deployment status

Mortality in men: all causes rate ratio 1.09, 95% CI 1.01-1.18; external causes rate ratio 1.17, 95% CI 1.07-1.29; all accidents rate ratio 1.26, 95% CI 1.11-1.42; motor-vehicle accidents rate ratio 1.27, 95% CI 1.09-1.48; suicide rate ratio 0.88, 95% CI 0.72-1.08

Crude death rate per 10,000 person-years; Cox proportional-hazards model adjusted for age, race, sex, service branch, type of unit

Interview data, small sample—alcohol-related accident group may have differed from suicides in undetected ways (unrecognized confounders)

Mortality in women: all causes rate ratio 1.32, 95% CI 0.95-1.83; external causes rate ratio 1.78, 95% CI

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