The Royal Commission into Defence and Veteran Suicide – brief summary and commentary on the research findings in Volume 7

Appendix H – comparative rates of suicide – current serving ADF members

For serving ADF members, there was an overall 30% increased risk of suicide compared to employed Australian males, which is even greater in particular combat and security roles (100%), including the infantry (153%) and Naval small arms specialists (453%). Those who faced trials or were convicted were over 13 times more likely to die by suicide. In contrast, reservists who had never served in the permanent force were 62% less likely to die by suicide than the general population of Australian males. Psychiatrists should therefore seek details of the roles and nature of veterans’ service in history-taking, in order to discern potential risk factors.

There was an important caveat reported by the Royal Commission that the low numbers of female data led to suppression of the information, to prevent identification, including of suicide-related data (e.g. p.68, Item 75 related to deployment type). (See Table 1 for a quick reference summary)

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Table 1.

ADF serving groups associated with higher rates of suicide

• Males serving in the permanent forces are 30% more likely to die by suicide than employed Australian males.

• Rates of suicide vary within the subpopulations of the current-serving cohort.

• Males serving in the permanent forces in combat and security roles and in the Navy are 2.5 times (150%) more likely to die by suicide compared to Australian employed males

• Riflemen are 2.53 times (153%) more likely to die by suicide than Australian employed males

• No deaths by suicide have been recorded for females serving in the permanent forces in combat and security roles from 2011 to 2020.

Appendix I – comparative rates of suicide – ex-serving ADF members

The important comparator for suicide rates was the general Australian population, as per advice from the Australian Institute of Health and Welfare (AIHW).

Male veterans who served in the permanent forces were significantly more likely to die by suicide than the general Australian male population. For instance, those in combat and security roles were 112% more likely to die by suicide than Australian males, while those in logistics roles were 69% more at risk. Males who separated involuntarily for medical reasons were 202% more likely to die by suicide than Australian males and those convicted of disciplinary offenses or who suffered traumatic injuries during service faced even greater risks. For example, males convicted of a section 24 offence (absence without leave) were 426% more likely to die by suicide rising to 1144% following conviction for prejudicial conduct. Finally, males who experienced musculoskeletal injuries were over three times more likely to die by suicide than Australian males.

Females who served in the permanent forces also had a significantly higher risk of suicide compared to the general Australian female population. This risk was particularly elevated for those in roles relating to combat and security (452%) or health (212%), as well as involuntary separation for medical reasons (388%) and “not in the service interest” (245%). Females who enlisted as minors in the reserve forces were also at a heightened risk of suicide (189%). Finally, those who suffered a traumatic joint, ligament, muscle, or tendon injury during service had 6 times the risk of suicide.

In summary, there were increased risks of suicide in both male and female veterans. Again, certain roles for males, such as Commando (which includes special forces operators) and Rifleman (combat), as well as Logistics had very high suicide risks. Males and females in combat and security roles had high rates of suicide. Again, for males and female, involuntary separation for medical reasons, or not being retained in service, increased suicide risk. Notably, females who served in health-related roles also had a heightened risk of suicide. Female reservists who enlisted as a minor also had increased risks of suicide. Males convicted of an offence, analogous to that for serving members, had increased suicide risk. Those with physical joint and soft tissue injuries also had markedly increased risks of suicide.

The clinical implications for psychiatrists are vigilance regarding the risks for female reservists who enlisted as minors, and ex-permanent female ADF that served in healthcare in addition to combat and security. The added risk of physical and soft tissue injuries for suicide prompts enquiry about the whole medical history. The other key issue, perhaps relating to professional identity, is the mode of separation, as those discharged medically or as unfit for service may bear particular psychological burdens or injuries. Also, the clinical experience of psychiatrists providing care for ADF is that those with musculoskeletal injuries face tremendous challenges accessing care and support, and this can further compound psychological injuries. (See Table 2 for a quick reference summary).

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Table 2.

ADF ex-serving groups associated with higher rates of suicide

• 854 deaths by suicide (34.9 per 100,000 population per year) for permanent ex-serving males

• 412 deaths by suicide (25.3 per 100,000 population per year) for reserve ex-serving males

• 62 deaths by suicide (15.6 per 100,000 population per year) for permanent ex-serving females

• 55 deaths by suicide (15.2 per 100,000 population per year) for reserve ex-serving females

Appendix J comparative hospital admissions for self-harm and mental health

Ex-service personnel, particularly those who served in the permanent forces, were significantly more likely to be admitted to public hospitals for self-harm related diagnoses compared to the general Australian population. This effect was more pronounced among females, who are 160% more likely to be admitted than Australian females. Older veterans and females who served in the permanent forces, were also at particular risk of being admitted to public hospitals for stress-related mental health conditions. For instance, ex-serving male patients aged 65 or more were 430% more likely to be admitted compared to Australian patients in the same age group. In terms of specific diagnoses, female veterans were more likely to be admitted for depression-related conditions, particularly in younger age groups, while males, especially older individuals, were more likely to be admitted for alcohol abuse.

The risks for admission to public hospitals for self-harm in ex-service personnel are therefore unacceptably high, as are those for stress-related mental health conditions, depression, and alcohol abuse. Importantly, this does not include data on private psychiatric admissions, which are covered by a number of programs that are available to current and former ADF members, and it is notable that PTSD and trauma-related disorders are among the most common diagnoses for private psychiatric hospital admissions. ⁴

Overall comments

It is not suggested that the above findings, as comprehensive and useful as they are, necessarily apply to all serving or ex-serving ADF personnel. However, the data may encourage psychiatrists caring for veterans to seek more detailed information on the type of ADF service, and the specific experiences that may lead to stress-related or depressive symptoms and the need for mental health care or admission.

There are also questions raised for further research, such as, for example, why there is a particular risk for logistics roles, and the mechanisms by which disciplinary action impacts upon ex-serving and serving ADF members. In addition, what are the particular adverse experiences faced by young female reservist roles, and also worryingly in another way, for those involved in healthcare? While the heightened risk of suicide experienced by personnel in combat and security roles is more understandable, more information is needed on how this might be mitigated.

The findings of greater risk are somewhat in contrast to previous findings of reduced risk, and those from the AIHW ‘Serving and ex-serving Australian Defence Force members who have served since 1985: suicide monitoring 1997 to 2022’ released in 2024. ³ For example, the study of 2017-2020 AIHW data, which examined suicide rates in the Australian Defence Force serving and ex-service personnel found that there were significantly lower suicide rates in both full-time and reservist members. ⁵ These findings were consistent with lower or comparable suicide rates in serving military personnel in the United Kingdom, Canada, United States, and New Zealand. ⁵ Interestingly, this did not apply to personnel who had left the ADF: ‘The rate of completed suicides in ex-serving ADF males, however, is more than double the rate for serving ADF males. The rate of completed suicides in ex-serving ADF men is higher than Australian men of the same age, and this rate is significantly higher in ex-serving ADF men aged below 30 years’ ⁵ (p.471). In 2021, it was concluded that there was insufficient information to analyse female ADF members or veterans’ suicide rates. A recent scoping review reinforces that the greatest risk of suicide is in those who have transitioned from the military, and that depression was most commonly associated with suicide. ⁶ Notably the Royal Commission report has possibly the most details on the role and nature of service, including disciplinary matters in comparison to prior research. ² The reasons for the apparent discrepancies with the Royal Commission report were cited at the beginning of our commentary, and largely relate to different research and statistical methodologies, but these are not described in detail in the Royal Commission report. ³

The detailed analysis of suicide risk for active, reserve and ex-service ADF members in the Royal Commission report reveals that if the data are scrutinised at a granular level, there appear to be identified higher suicide risks for certain subpopulations, in comparison with working age or the general Australian population respectively. However, as indicated at the outset, the Royal Commission cautioned against risk profiling on the basis of the data. Nonetheless, it has been informative to see the data for female ADF serving or ex-service personnel. We would encourage regular AIHW monitoring of defence force related suicides.

Given these findings, perhaps it is also reasonable, with regard to the Royal Commission’s recommendation on the need to improve transition to civilian life and accessing care, ² to consider also how to discuss how long ADF members should serve, and in what capacity. There is an analogous consideration for all first responder professions, including the military, police, paramedics/ambulance officers, firefighters, and frontline healthcare workers – how long can a career be sustained, and when and how to navigate leaving the profession, and of course, developing an identity? As the epigraph reminds, no profession, such as military service should expect a higher suicide rate than that of the general population. If the medical profession is to be of service to those who have served, it must consider the evidence, encourage research into effective interventions, and provide care as is practicable on an individualised basis.