Mysterious Military Suicide Patterns

I was doing some work regarding identification of genes that have an association with suicide (looking at you, SKA2) and found myself thinking about suicide patterns. In particular, I was thinking about a 2013 report that military suicides had increased to the point where there were more suicides than combat casualties (terrible, awful idea for a military commercial: "Marines: so tough that the only ones who can kill us are... ourselves). This thread led me to the following question: did invading Iraq/Afghanistan cost more lives than doing nothing? Did we (our government, but us in effect) kill more of ourselves trying to solve a problem than died in the precipitating incident?

So I took a gander at casualties, which led me to suicides which led me to thinking about the article I'd mentioned. There are some underlying assumptions for this idea, one of them being that there is an association between combat and PTSD which would be reflected in an elevated suicide rate. I had a hypothesis about this: more combat = more suicides. 

So I looked it up. And my hypothesis didn't survive (no pun intended) first contact with the data. For one thing, there was no appreciable uptick in suicides in veterans following the war (my numbers come from this VA report, which I cite throughout this post). So sending a wave of people into battle didn't directly correlate with suicides. 

With my original idea dead in the water, I picked through the rest of the report and began to notice something else interesting: military suicides have a markedly different pattern. For most of us (and by us, I mean white men - suicide prevalence is highest among my male Caucasian brethren), suicide rates rise as we move into adulthood, peaking around the time of greatest career/family responsibility, then tapering off. In the military, however, this peak is delayed by some ten years - 50-59 is where the real peak is. This means that the vast majority of suicides in the military come from individuals who have been separated for some time.  

I'm fascinated by this, although I don't have a good explanation. What happens in a veteran's life to make the peak here, when the average civilian is stabilizing from their desire to self-harm. 

I've never heard a compelling description of this phenomenon, and I really don't know what to make of it. A few ideas:

- Cumulative effects of PTSD. Although only a minority of the armed forces see combat (although it's popular to claim disability whether you do or don't). It's worth pointing out that being in the military isn't particularly dangerous, from an occupational standpoint. Your odds of dying on a construction site are much higher than dying in Fallujah or Kandahar.  

- Personality trait of people who are attracted to military service. I once shared an Uber pool with a recently-separated marine who expressed regret he was unable to kill any Afghans during his time in service. The guy seemed like the type who could kill himself (or others), although it could be a slow burn. 

- Stress related to delayed life events. I.e., delaying family/civilian career shifts the normal problems that cause suicide some 10-15 years back. This could include added stress of reintegration and high poverty rates among veterans. 

​To be honest, none of these feel like the exact answer. 

Also buried in the report is the high use of death-by-pills among veterans. This is a traditionally feminine method of suicide, if I recall correctly. It brings another idea up: substance abuse deaths that are accidental overdoses being reported as suicides. 

Perhaps the only part of my hypothesis that survived is that there is a very real cost (in lives, but also money) to military deployment. 

---

A final note - military suicide rates are probably affect by something. Check out the attached pic: while suicide rates are fairly constant for civilians, military suicides jump up and down, even in the air force, which rarely has in-your-face type of trauma. 

Would love to hear thoughts on this. 

---