Predictors of remission and progression of suicidal ideation in the Canadian Armed Forces: A 16-year nationally representative longitudinal study

Introduction: Given that suicidal ideation is a key risk factor for future suicidal behaviour, socio-economic and psychosocial factors that influence the critical transition period between suicidal ideation, plans, and attempts in the military should be examined. This study assessed correlates of remission and progression (i.e., worsening) of suicidality in a 16-year prospective, nationally representative sample of Canadian Armed Forces members and Veterans. Methods: The 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (n = 2,941) is a follow-up of respondents of the 2002 Canadian Community Health Survey – Canadian Forces Supplement. The reporting of suicidal ideation (SI) in 2002 was used to create three groups in 2018: 1) remission (no SI, suicidal plans [SP], or suicidal attempts [SA] “since last interview”), 2) persistence (SI “since last interview”, but not SP or SA), and 3) progression (SP and/or SA “since last interview”). Results: Relative to SI persistence, all six mental disorders examined in 2018 were negatively associated with SI remission (odds ratio [OR] range = 0.29-0.42) or positively associated with SI progression (OR range = 3.69-5.92). Coping styles and deployment had statistically significant associations with remission, while military environmental command, military rank, physical health conditions, and traumatic exposure were significantly associated with progression. Discussion: Potential interventions could focus on developing psychological strategies to enhance resilience to trauma, fostering strategies that allow individuals to receive appropriate treatment for their mental disorders and physical health conditions, and promoting problem-focused coping styles.