Study Design










1.16-2.73; all accidents rate ratio 1.83, 95% CI 1.02-3.28; motor-vehicle accidents rate ratio 1.81, 95% CI 0.96-3.41; suicide rate ratio 1.47, 95% CI 0.63-3.43



Kang and Bullman 2001

Retrospective cohort; initial study was 2.4 years; this study was nearly 7 years

621,902 GW-deployed veterans, 746,248 nondeployed veterans (stratified random sample of all military personnel, including active-duty, reserves, National Guard units who served during conflict but not deployed in Persian Gulf)

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 0.95, 95% CI 0.92-0.99; external causes rate ratio 1.04, 95% CI 0.99-1.10; all accidents rate ratio 1.15, 95% CI 1.07-1.23; motor-vehicle accidents rate ratio 1.19, 95% CI 1.09-1.30; suicide rate ratio 0.92, 95% CI 0.83-1.02

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)

(Followup to Kang and Bullman 1996)

Mortality in women: all causes rate ratio 1.16, 95% CI 0.97-1.38; external causes rate ratio 1.39, 95% CI 1.08-1.80; all accidents rate ratio 1.36, 95% CI 0.95-1.96; motor-vehicle accidents rate ratio 1.63, 95% CI 1.09-2.45; suicide rate ratio 1.29, 95% CI 0.78-2.31

MHAT 2006a

Survey of OIF troops during deployment in Iraq

1320 U.S. Army soldiers (79% active-duty, 8% reserve, 13% National Guard), 447 Marines

MHAT Soldier and Marine Well-Being Survey of anonymous troops; observations by authors; focus-group interviews; behavioral-health surveys, primary care, unit ministry-care surveys

Suicide rate in Iraq (per 100,000) 18.8 (2003), 9.6 (2004), 19.9 (2005), 16.1 (2006), p < 0.01; U.S. Army 10-year average suicide rate 11.6 per 100,000 year

Report states suicide rates were adjusted, but no details given

Report is prepared periodically as requested by Army; it is not a formal, methodologically rigorous survey, but is included because it contains recent data on troops surveyed in Iraq

NOTE: BIRLS = Beneficiary Identification Record Locator Subsystem Death File, BMI = body-mass index, CI = confidence interval, GW = Gulf War, ICD-9 = International Statistical Classification of Diseases, 9th edition, MHAT = Mental Health Advisory Team, NDI = National Death Index, OIF = Operation Iraqi Freedom, OR = odds ratio, SSA = Social Security Administration, VA = Department of Veterans Affairs, VES = Vietnam Experience Study.

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