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Examination of the indirect effects of combat exposure on suicidal behavior in veterans.

Publication ,  Journal Article
Dillon, KH; Cunningham, KC; Neal, JM; Wilson, SM; Dedert, EA; Elbogen, EB; Calhoun, PS; Beckham, JC; VA Mid-Atlantic MIRECC Workgroup, ; Kimbrel, NA
Published in: J Affect Disord
August 1, 2018

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.

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Published In

J Affect Disord

DOI

EISSN

1573-2517

Publication Date

August 1, 2018

Volume

235

Start / End Page

407 / 413

Location

Netherlands

Related Subject Headings

  • Veterans
  • United States
  • Surveys and Questionnaires
  • Suicide
  • Suicidal Ideation
  • Stress Disorders, Post-Traumatic
  • Self Report
  • Psychiatry
  • Military Personnel
  • Male
 

Citation

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ICMJE
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Dillon, K. H., Cunningham, K. C., Neal, J. M., Wilson, S. M., Dedert, E. A., Elbogen, E. B., … Kimbrel, N. A. (2018). Examination of the indirect effects of combat exposure on suicidal behavior in veterans. J Affect Disord, 235, 407–413. https://doi.org/10.1016/j.jad.2018.04.031
Dillon, Kirsten H., Katherine C. Cunningham, Julia M. Neal, Sarah M. Wilson, Eric A. Dedert, Eric B. Elbogen, Patrick S. Calhoun, Jean C. Beckham, Jean C. VA Mid-Atlantic MIRECC Workgroup, and Nathan A. Kimbrel. “Examination of the indirect effects of combat exposure on suicidal behavior in veterans.J Affect Disord 235 (August 1, 2018): 407–13. https://doi.org/10.1016/j.jad.2018.04.031.
Dillon KH, Cunningham KC, Neal JM, Wilson SM, Dedert EA, Elbogen EB, et al. Examination of the indirect effects of combat exposure on suicidal behavior in veterans. J Affect Disord. 2018 Aug 1;235:407–13.
Dillon, Kirsten H., et al. “Examination of the indirect effects of combat exposure on suicidal behavior in veterans.J Affect Disord, vol. 235, Aug. 2018, pp. 407–13. Pubmed, doi:10.1016/j.jad.2018.04.031.
Dillon KH, Cunningham KC, Neal JM, Wilson SM, Dedert EA, Elbogen EB, Calhoun PS, Beckham JC, VA Mid-Atlantic MIRECC Workgroup, Kimbrel NA. Examination of the indirect effects of combat exposure on suicidal behavior in veterans. J Affect Disord. 2018 Aug 1;235:407–413.
Journal cover image

Published In

J Affect Disord

DOI

EISSN

1573-2517

Publication Date

August 1, 2018

Volume

235

Start / End Page

407 / 413

Location

Netherlands

Related Subject Headings

  • Veterans
  • United States
  • Surveys and Questionnaires
  • Suicide
  • Suicidal Ideation
  • Stress Disorders, Post-Traumatic
  • Self Report
  • Psychiatry
  • Military Personnel
  • Male