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Examination of the indirect effects of combat exposure on suicidal behavior in veterans.
J Affect Disord. 2018 08 01; 235:407-413.JA

Abstract

BACKGROUND

Researchers have theorized that increased rates of suicide in the military are associated with combat exposure; however, this hypothesis has received inconsistent support in the literature, potentially because combat exposure may be indirectly related to suicide risk through its influence on posttraumatic stress disorder (PTSD) and depressive symptoms. The current study tested the hypothesis that combat exposure has a significant indirect effect on suicidal behavior among Iraq/Afghanistan-era veterans through its effects on PTSD-depressive symptomatology.

METHODS

Iraq/Afghanistan-era veterans (N = 3,238) participated in a cross-sectional, multi-site study of post-deployment mental health consisting of clinical interviews and self-report questionnaires. Structural equation modeling (SEM) was used to examine direct and indirect relationships between three latent variables: combat exposure, PTSD-depression, and suicidal behavior (past attempts and current ideation, intent, and preparation).

RESULTS

A partial mediation model was the best-fitting model for the data. Combat exposure was significantly associated with PTSD-depression (β = 0.50, p < .001), which was in turn associated with suicidal behavior (β = 0.62, p < .001). As expected, the indirect effect between combat exposure and suicidal behavior was statistically significant, β = 0.31, p < .001.

LIMITATIONS

Data were cross-sectional, and suicidal behavior was measured via self-report.

CONCLUSIONS

Results indicated that combat exposure was indirectly related to suicidal behavior via PTSD-depressive symptomatology. Findings lend support for a higher-order combined PTSD-depression latent factor and suggest that Iraq/Afghanistan-era veterans with high levels of PTSD-depressive symptoms are at increased risk for suicidal behavior.

Authors+Show Affiliations

Duke University Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA.VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA.Duke University Medical Center, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA.Duke University Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA; VA Center for Health Services Research in Primary Care, Durham, NC, USA.Duke University Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA.Duke University Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA.Duke University Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA; VA Center for Health Services Research in Primary Care, Durham, NC, USA.Duke University Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA.VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.Duke University Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA. Electronic address: nathan.kimbrel@va.gov.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

29677605

Citation

Dillon, Kirsten H., et al. "Examination of the Indirect Effects of Combat Exposure On Suicidal Behavior in Veterans." Journal of Affective Disorders, vol. 235, 2018, pp. 407-413.
Dillon KH, Cunningham KC, Neal JM, et al. Examination of the indirect effects of combat exposure on suicidal behavior in veterans. J Affect Disord. 2018;235:407-413.
Dillon, K. H., Cunningham, K. C., Neal, J. M., Wilson, S. M., Dedert, E. A., Elbogen, E. B., Calhoun, P. S., Beckham, J. C., & Kimbrel, N. A. (2018). Examination of the indirect effects of combat exposure on suicidal behavior in veterans. Journal of Affective Disorders, 235, 407-413. https://doi.org/10.1016/j.jad.2018.04.031
Dillon KH, et al. Examination of the Indirect Effects of Combat Exposure On Suicidal Behavior in Veterans. J Affect Disord. 2018 08 1;235:407-413. PubMed PMID: 29677605.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Examination of the indirect effects of combat exposure on suicidal behavior in veterans. AU - Dillon,Kirsten H, AU - Cunningham,Katherine C, AU - Neal,Julia M, AU - Wilson,Sarah M, AU - Dedert,Eric A, AU - Elbogen,Eric B, AU - Calhoun,Patrick S, AU - Beckham,Jean C, AU - ,, AU - Kimbrel,Nathan A, Y1 - 2018/04/11/ PY - 2017/11/30/received PY - 2018/03/06/revised PY - 2018/04/04/accepted PY - 2018/4/21/pubmed PY - 2018/12/24/medline PY - 2018/4/21/entrez KW - Combat exposure KW - Depression KW - PTSD KW - Suicide SP - 407 EP - 413 JF - Journal of affective disorders JO - J Affect Disord VL - 235 N2 - BACKGROUND: Researchers have theorized that increased rates of suicide in the military are associated with combat exposure; however, this hypothesis has received inconsistent support in the literature, potentially because combat exposure may be indirectly related to suicide risk through its influence on posttraumatic stress disorder (PTSD) and depressive symptoms. The current study tested the hypothesis that combat exposure has a significant indirect effect on suicidal behavior among Iraq/Afghanistan-era veterans through its effects on PTSD-depressive symptomatology. METHODS: Iraq/Afghanistan-era veterans (N = 3,238) participated in a cross-sectional, multi-site study of post-deployment mental health consisting of clinical interviews and self-report questionnaires. Structural equation modeling (SEM) was used to examine direct and indirect relationships between three latent variables: combat exposure, PTSD-depression, and suicidal behavior (past attempts and current ideation, intent, and preparation). RESULTS: A partial mediation model was the best-fitting model for the data. Combat exposure was significantly associated with PTSD-depression (β = 0.50, p < .001), which was in turn associated with suicidal behavior (β = 0.62, p < .001). As expected, the indirect effect between combat exposure and suicidal behavior was statistically significant, β = 0.31, p < .001. LIMITATIONS: Data were cross-sectional, and suicidal behavior was measured via self-report. CONCLUSIONS: Results indicated that combat exposure was indirectly related to suicidal behavior via PTSD-depressive symptomatology. Findings lend support for a higher-order combined PTSD-depression latent factor and suggest that Iraq/Afghanistan-era veterans with high levels of PTSD-depressive symptoms are at increased risk for suicidal behavior. SN - 1573-2517 UR - https://www.unboundmedicine.com/medline/citation/29677605/Examination_of_the_indirect_effects_of_combat_exposure_on_suicidal_behavior_in_veterans_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-0327(17)32443-6 DB - PRIME DP - Unbound Medicine ER -