Characteristics of ex-serving Australian Defence Force members hospitalised for suicidality and intentional self-harm

This report commences by providing an overview of the characteristics of ex-serving ADF members who were admitted for patient care for any reason during the period 2010-2020. This overview includes a presentation of which subgroups of ex-serving members are using admitted patient care and the reasons for using admitted care. The purpose of this overview is to contextualise the use of admitted patient care by ex-serving members for conditions associated with suicidal behaviour.

Between 2010 and 2020, there were 98,200 ex-serving ADF members who received admitted patient care for any reason, including 81,300 males and 16,900 females. 

Which ex-serving ADF members received admitted patient care?

This section describes the demographic and military characteristics of ex-serving ADF members who received admitted patient care (or admitted to a public hospital) for any reason at a participating hospital from 1 July 2010 to 30 June 2020, unless otherwise stated. It does not include emergency department care.

Table 10 in Technical notes provides the figures which are used in this section.

Age

Age patterns of male and female ex-serving members who received admitted patient care were generally similar to the age structure of the ex-serving population group. Most ex-serving ADF members who received admitted patient care were aged 35 to 54 years (54.1% for males and 62.8% for females). The main differences between the total ex-serving population and ex-serving members who were admitted was that a higher proportion of ex-serving females were aged 25-34 of those who received admitted patient care (19.4% compared with 12.2% for all ex-serving females) and a lower proportion of ex-serving females were aged 45-54 of those who received admitted patient care (29.7% compared with 37.5% for all ex-serving females).

Service

The ADF has three service branches: The Royal Australian Navy (Navy), the Australian Army (Army) and the Royal Australian Air Force (Air Force). Members may move between services however this analysis only counts service at separation. Most ex-serving ADF members served in the Army at separation (69% for males and 63% for females).

Of ex-serving members who received admitted patient care: 

• Most ex-serving ADF members who received admitted patient care had separated from the Army (68.9% for males and 63.9% for females).
• Most ex-serving ADF members who received admitted patient care and died by suicide had separated from the Army (75.6% for males and 69.1% for females).

These results approximately reflect the service branch composition of the ADF. 

Rank

Rank describes organisational and workforce structures that determine an ADF member’s position, conditions, entitlements and opportunities. It is reported here as rank at time of separation from the ADF in three groups: Commissioned Officer (for example Major), Senior other rank (for example Warrant Officer) and Other rank (for example Seaman). 

Of the ex-serving ADF members who received admitted patient care, at least 10% were Commissioned Officers at time of separation. ‘Other ranks’ comprised at least 65% of ex-serving ADF members who received admitted patient care.

The proportions of the rank categories for those who received admitted patient care were similar to those for the broader ex-serving population.

Length of service

Length of service describes the time between joining the ADF and separation. This report presents, length of service in five groups, ranging from less than 1 year to 20 years or more. At the time of separation from the ADF the most common length of service for ex-serving ADF members who received admitted patient care during this period was between 1 and 5 years (26.6% for males and 34.1% for females). The proportions of ex-serving members for those who received admitted patient care had similar lengths of service to the broader ex-serving population except for a comparatively higher proportion of males with 20 years or longer service being admitted (24.5% compared with 20.8%).

Time since service

The time between separation from the ADF and admission is presented in 5 groups ranging from less than 1 year to 20 years or more. Most ex-serving ADF members had been separated from the ADF for at least 10 years when admitted to a participating hospital (73.3% for males and 66% for females). The proportions of ex-serving members by time since service for those who received admitted patient care were similar to the broader ex-serving population except for a comparatively lower proportion of females who served 20 years or more being admitted (31.7% compared with 39.7%).

Reason for separation from the ADF

The reasons that ADF members leave the ADF can be categorised into four broad groups: voluntary separation, involuntary medical separation, involuntary other separation and contractual or administrative change. This is based on complete separation from the ADF, or in other words, no further permanent or reserve service being undertaken by the ADF member. 

The most common type of reason for separation in the ex-serving ADF members group was voluntary separation, with similar proportions for males (42.1%) and females (43.6%). This was followed by involuntary other separation (35.1% for males and 28.2% for females), involuntary medical separation (13% for males and 15.7% for females), and contractual or administrative change (9.7% for males and 12.5% for females). 

Of ex-serving members who received admitted patient care: 

• The most common reason for separation from the ADF was voluntary (37.8% for males and 41.9% for females)
• Around 20% had separated from the ADF involuntarily due to medical reasons.

Of ex-serving ADF members who died by suicide and received admitted patient care for any reason prior to their death:

• The most common reason for separation from the ADF was voluntary (67.3% for males and 77.5% for females)
• Around 14% of males had separated from the ADF involuntarily due to medical reasons.

DVA client status

Ex-serving DVA clients are a sub-population of ex-serving ADF members and have different characteristics to the all ex-serving ADF members cohort. ADF members who are eligible for DVA support – and who access services funded by DVA – are more likely to have physical and mental health needs that would have led them to DVA. For the purposes of this report, the definition of a DVA client is an ex-serving ADF member who has at least one of the following:

• been issued a White, Orange or Gold health card
• had at least one accepted claim for a health or disability condition accepted as being related to service
• has received or is receiving benefits or payment from DVA
• had at least one health service or support service through the DVA National Treatment Account.

A Gold health card provides eligible DVA clients with comprehensive health services, including admitted patient care for all conditions, while a white card provides services for specific medical conditions. Other health services funded or provided by DVA to eligible ex-serving ADF members may include admitted patient care depending on the condition and the circumstances (DVA health support). For more information and definition of the DVA client cardholder types, see Technical notes.

• A greater proportion of admitted patients were DVA clients compared to the proportion of ex-serving members who were DVA clients. This was true for both males (33.1% vs 27.5%) and females (22.3% vs 19.6%).
• There was a higher proportion of ex-serving ADF members who received admitted patient care and were DVA clients for each client type (Gold cardholders, White cardholders and other clients).

Why were ex-serving ADF members admitted to hospital?

While the focus of this report is on conditions associated with suicidal behaviour, this section presents an overview of the range of reasons for patients’ hospital admissions to contextualise admissions related to suicidal behaviour.

The reasons for admission are presented based on principal diagnosis (see Box 2) with consideration of differences being driven by sex and age. This section discusses admitted patient care for persons based on 2019-20 data. See supplementary table S.PUB.1.1 for data for July 2010 to June 2020.

Analysis of reasons for admission is based on International Statistical Classification of Diseases and related health problems, 10^th revisions, Australian Modification (ICD-10-AM) chapters (broad diagnosis groups). See Technical Notes for full codes and classification.

Overall, the most common principal diagnoses among those accessing admitted patient care services in public hospitals were similar for both ex-serving ADF members and the total Australian population. 

In the financial year 2019-2020:

• The three most common principal diagnoses for ex-serving ADF members admitted to public hospitals were symptoms and signs, injury and poisoning and digestive diseases.
• As a proportion of all admitted patients to public hospitals, more ex-serving ADF male members than all Australian males were admitted with principal diagnoses of mental and behavioural disorders (7.1% vs 5.7%).
• The proportion of ex-serving ADF females admitted for mental and behavioural disorders (5.0%) was greater than for all Australian females (4.2%). However, mental and behavioural disorders was not among the top ten most common principal diagnoses for ex-serving ADF females and all Australian females admitted to public hospitals.

Age

There were different reasons for admission among the ex-serving ADF population and all Australian population across select age groups. Of patients admitted to public hospitals in 2019-2020, compared to all Australians (see supplementary table S.PUB.1.2):

• a higher proportion of male ex-serving ADF members aged 35-44 years were admitted for mental and behavioural disorders (13.0% vs 10.2%)
• a lower proportion of male ex-serving ADF members aged 65+ years were admitted for eye diseases (3.1% vs 5.7%)
• a higher proportion of male ex-serving ADF members aged 25-34 years were admitted for mental and behavioural disorders (13.4% vs 11.0%)
• a higher proportion of female ex-serving ADF members aged 65 and older were admitted for digestive diseases (19.0% vs 12.5%)
• a higher proportion of female ex-serving ADF members aged 35-44 years were admitted for injury and poisoning (8.4.% vs 14.7%)
• a lower proportion of female ex-serving ADF members aged 25-34 years were admitted for pregnancy and childbirth (47.5% vs 55.9%).

DVA client status

Ex-serving DVA clients are a sub-population of ex-serving ADF members and have different characteristics to the total ex-serving ADF member cohort. ADF members who are eligible for DVA support – and who access services funded by DVA – are more likely to have physical and mental health needs that would have led them to DVA. There may also be other reasons that DVA clients have higher admissions such as greater access to hospital care. The reasons for admissions to hospital differed between ex-serving members who were DVA clients and those who were non-DVA clients (see supplementary table S.PUB.1.3).

Among ex-serving patients admitted to public hospitals (FY 2019-20), compared to non-DVA clients:

• a higher proportion of male and female DVA clients were admitted for mental and behavioural disorders (males 8.5% vs 6.1%; females 6.1% vs 4.6%)
• a higher proportion of male and female DVA clients were admitted for respiratory system diseases (males 7.3% vs 5.9%; females 6.1% vs 4.6%)
• a lower proportion of male and female DVA clients were admitted for digestive diseases (males 14.3% vs 16.9%; females 12.1% vs 13.6%)
• a lower proportion of female DVA clients were admitted for neoplasms (5.4% vs 8.2%)

• a higher proportion of female DVA clients were admitted for injury and poisoning (15.6% vs 13.4%).