# Character of Discharge From the US Military and Suicide Mortality

## TL;DR

This study finds that US military veterans who received non-honorable discharges have a significantly higher risk of suicide compared to those with honorable discharges.

## Contribution

The study provides the first comprehensive evaluation of suicide risk associated with different types of military discharge character classifications.

## Key findings

- Veterans with non-honorable discharges had suicide rates up to 2.77 times higher than those with honorable discharges.
- Honorable discharge recipients had lower suicide rates compared to the overall veteran population recently separated from service.
- Common demographic risk factors for suicide were consistent across discharge categories.

## Abstract

What is the association of characters of discharge from US military service with risk of suicide?

In this cohort study of 3 627 653 individuals, those who received a dishonorable/bad conduct, other than honorable, general, or uncharacterized character of discharge had significantly higher rates of suicide after separation from military service compared with those who had received an honorable character of discharge.

These findings support suicide prevention services for individuals who do not receive an honorable discharge from military service.

This cohort study examines suicide mortality rates by character of service discharge among US military veterans.

Suicide risk may be elevated among individuals who separate from military service with a character of discharge or service that was not honorable (ie, dishonorable, bad conduct, other than honorable, general, or uncharacterized), but a comprehensive evaluation of this possibility has not been previously published.

To examine suicide mortality by character of discharge compared with individuals who received an honorable discharge and the full veteran population recently separated from service.

This retrospective cohort study included all individuals who separated from the active component of the US military between January 1, 2002, and December 31, 2021. Data were obtained from the US Department of Veterans Affairs/Department of Defense Mortality Data Repository. Suicide rates for each character of discharge were compared with those among individuals receiving an honorable discharge and the full veteran population recently separated from service. Analyses were conducted between December 21, 2023, and June 1, 2024.

Character of discharge assigned at separation from the active component of military service.

Crude suicide rates up to 5 years after separation were examined. Age-standardized rate ratios were used for comparisons within the cohort between strata. Age-standardized mortality ratios (SMRs) were used to compare suicide mortality by character of discharge with the full separation cohort and within specific military service branches.

Among 3 627 653 individuals (mean [SD] age at separation, 28.4 [8.6] years; 83% men), 5599 deaths by suicide occurred during the study period. All character of discharge groups had significantly higher suicide rates than the honorable group, with standardized rate ratios ranging from 1.91 (95% CI, 1.69-2.17) for uncharacterized to 2.77 (95% CI, 2.52-3.05) for general. Veterans who received an honorable discharge were less likely to die by suicide than the overall cohort population (SMR, 0.82 [95% CI, 0.79-0.85]), while veterans with all other characters of discharge were more likely to die by suicide, with SMRs ranging from 1.23 (95% CI, 1.15-1.31) for uncharacterized to 1.84 (95% CI, 1.72-1.97) for general. Common demographic risk factors for suicide (eg, age, race) were replicated within character groups in most cases.

In this cohort study, individuals who did not receive an honorable character of discharge were at significantly higher risk of suicide compared with veterans who received an honorable discharge and the veteran population recently separated from service. These findings suggest that character of discharge may be a helpful risk factor to consider for ongoing suicide prevention efforts.