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

In general, ADF members are encouraged to be physically and mentally fit, receive regular medical assessments, and have access to comprehensive medical and dental treatment.

ADF members can, however, face stressors from exposure to combat, geographical relocations, and lengthy separation from family and support networks. The health of ADF members may be affected differently given the member’s gender, age, service branch, rank, length of service, and for ex-serving members due to the time since service and the circumstances of their discharge from the ADF.

In order to better manage the particular needs of ADF members, it is important to understand their experiences and how their characteristics and needs may differ from other Australians. This includes examining the characteristics of members associated with suicidality and self-harm.

This report examines the characteristics of ex-serving members using a newly established data asset of public hospital service use (including admitted patient care and emergency departments). It specifically focuses on public hospital care for conditions associated with suicidal behaviour, including mental health-related care, alcohol and other drug use, and intentional self-harm, to identify the particular characteristics and care needs of ADF members.

More specifically, AIHW analyses the proportion of ex-serving members who received public hospital care in 2019-20 and who received that care primarily for conditions associated with suicidal behaviour. Comparisons to other hospitalised Australians are used to provide context and better understand the specific care needs of ADF service members.

This report makes two key comparisons of people using public hospital services: firstly, between ex-serving ADF members who used hospitals services throughout the study period and the total Australian population who used hospital services, and secondly, hospital service use prior to death among those who died by suicide within these groups.

These data contribute to a more complete picture of the characteristics of ex-serving ADF members and how their public hospital care needs may differ from the rest of the population. It is important to remember that not all people who experience these issues will go to public hospital. Some may not seek care and/or may access alternative models of care, including private hospitals. These data cannot be used as a measure of the prevalence or incidence of health conditions either within the ex-serving ADF population or the general population.

Public hospital admitted patient care for ex-serving members was more likely to be for mental health-related care compared to all Australians

Of people admitted to public hospital in 2019-20, the proportion of ex-serving ADF members who had at least one hospitalisation primarily for mental health-related care was relatively high compared to those from the total Australian population (8.1% compared with 6.6% for males and 6.1% compared with 5.0% for females).

The proportion of ex-serving members who had at least one hospitalisation primarily for mental health-related care varied by age. Ex-serving males aged 35-44 years had the highest proportion of hospitalisation for mental health-related care (14.6%) relative to the Australian male population in that age group (11.4%). The rates were similar for males aged 17-24 and those aged 65 years and over. 

For females, ex-serving members aged 25-34 had relatively higher rates of admission for mental health-related care at 7.4% compared to 4.9% in the Australian female population in that age group.

The proportion of ex-serving males admitted to public hospitals who had at least one hospitalisation primarily for stress-related disorders was 1.7% compared to 0.5% for all Australian males. Similarly, the proportion of ex-serving males admitted to public hospitals who had at least one hospitalisation primarily for depression was higher for ex-serving males aged 35-54 years compared to the same aged Australian male population.

Higher proportions of admission for mental health-related care in ex-serving males was associated with specific ADF service factors such as:

• Army (8.4%) or Navy (8.7%) service compared to RAAF (5.9%) service for ex-serving males
• shorter lengths of service for ex-serving males; service of less than one year (10.8%), and between 1 and less than 5 years (10.7%) compared to service of at least 5 years but less than 10 years (8.5%), and 10 or greater years (5.6%)
• other ranks for ex-serving males – junior and unspecified (9.2%), compared to officers (6.1%) and senior other ranks (4.7%)
• involuntary separation – especially involuntary medical separation (19.6%), compared to voluntary separation (8.1%) for ex-serving males.

Similar patterns for ADF factors were observed for both ex-serving males and females for admitted patient care relating to alcohol and other drug use and intentional self-harm.

A higher proportion of ex-serving ADF members in the hospitalised group had at least one admission for alcohol and other drug related conditions than in the total male and female hospitalised population (males was 3.8% compared with 3.2% respectively and females was 3.1% compared with 1.9%). Of those with an admission for alcohol and drug related care, 53.8% of ex-serving males had an admission for alcohol use (compared with 46.0% in the total population).

Higher proportions of ex-serving ADF males and females who were admitted to a public hospital were admitted for intentional self-harm compared to the total Australian population for each year between July 2010 and June 2020.

Emergency department presentations for ex-serving ADF members were more likely to be related to suicidal behaviours than for all Australians

Between 2013 and 2020, about 4,400 ex-serving ADF members presented to an emergency department (ED) for self-harm or suicidal behaviour. This accounted for 3.7% of all ED presentations among ex-serving ADF members, above the rate of 2.8% for all Australians.

Across all age groups, the proportion of presentations to EDs by ex-serving males that were for self-harm or suicidal behaviour was 3.7%. This was up to 1.6 times higher among ex-serving males (for those aged 65+) compared with all Australian males. A similar pattern was seen among ex-serving females, except for those aged 65 years and over (where there was no significant difference).