Suicide Risk Among US Peacekeepers Serving in the Bosnia and Kosovo Theater, 1996–2002

The risk of suicide among US military personnel deployed for peacekeeping missions is unknown. We compared the risk of suicide through December 2014 among 70,608 veterans who deployed as peacekeepers to Bosnia and Kosovo between 1996 and 2002 with that of 141,715 veterans who served in the military between 1996 and 2002 but were not deployed to Bosnia and Kosovo. Both cohorts also were compared after removing those who had other conflict deployments. Suicide risk among Bosnia- and Kosovo-deployed veterans (BKDVs) relative to non-BKDVs was assessed using a hazard ratio. Among all veterans, without excluding those with other conflict deployments, deployment to Bosnia and Kosovo was not associated with an increased risk of suicide (hazard ratio = 0.83, 95%, confidence interval: 0.72, 0.96). Removing those with other conflict deployments, BKDVs again had a decreased risk of suicide compared to non-BKDVs (hazard ratio = 0.84, 95% confidence interval: 0.72, 0.99). The rates of suicide among all 4 groups were higher than expected based on the US population. The risk of suicide based on US population comparison was greater among non-BKDVs than BKDVs. The absence of an increased risk of suicide associated with Bosnia and Kosovo deployment may be due to predeployment psychological and behavioral characteristics that affect fitness for deployment.