The factor structure of psychiatric comorbidity among Iraq/Afghanistan-era veterans and its relationship to violence, incarceration, suicide attempts, and suicidality

Journal Article

© 2014. The present research examined how incarceration, suicide attempts, suicidality, and difficulty controlling violence relate to the underlying factor structure of psychiatric comorbidity among a large sample of Iraq/Afghanistan-era veterans (N=1897). Diagnostic interviews established psychiatric diagnoses; self-report measures assessed history of incarceration, difficulty controlling violence, suicide attempts, and suicidality. A 3-factor measurement model characterized by latent factors for externalizing-substance-use disorders (SUD), distress, and fear provided excellent fit to the data. Alcohol-use disorder, drug-use disorder, and nicotine dependence were indicators on the externalizing-SUD factor. Posttraumatic stress disorder and depression were indicators on the distress factor. Panic disorder, social phobia, specific phobia, and obsessive-compulsive disorder were indicators on the fear factor. Incarceration was exclusively predicted by the externalizing-SUD factor. Difficulty controlling violence, suicidality, and suicide attempts were exclusively predicted by the distress factor. Contrary to hypotheses, the path from the externalizing/SUD factor to difficulty controlling violence was not significant. Taken together, these findings suggest that the distress factor of psychiatric comorbidity is a significant risk factor for suicidality, suicide attempts, and difficulty controlling violence and could help to explain the frequent co-occurrence of these critical outcomes among returning Iraq/Afghanistan veterans.

Full Text

Duke Authors

Cited Authors

  • Kimbrel, NA; Calhoun, PS; Elbogen, EB; Brancu, M; Beckham, JC; Green, KT; Kirby, AC; Dennis, MF; Hoerle, J; Wagner, HR; Runnals, J; Van Voorhees, E; Fairbank, JA; Moore, SD; Weiner, RD; Straits-Troster, K; Tupler, LA; Marx, CE; Morey, RA; Miller-Mumford, M; McDonald, SD; Taber, KH; Yoash-Gantz, RE; Hurley, RA

Published Date

  • January 1, 2014

Published In

Volume / Issue

  • 220 / 1-2

Start / End Page

  • 397 - 403

Electronic International Standard Serial Number (EISSN)

  • 1872-7123

International Standard Serial Number (ISSN)

  • 0165-1781

Digital Object Identifier (DOI)

  • 10.1016/j.psychres.2014.07.064

Citation Source

  • Scopus