Moral injury entails emotional distress associated with perceived violations of one's moral code and has been proposed to be a possible contributor to self-injurious thoughts and behaviors (SITB) among military personnel. Three dimensions of moral injury have previously been empirically derived: transgressions committed by others (Transgressions-Others), transgressions committed by oneself (Transgressions-Self), and perceived betrayal by others (Betrayal). The current study examined the relationship of these dimensions of moral injury with SITB in a clinical sample of 151 active duty military personnel. Transgressions-Other and Transgressions-Self were significantly higher among personnel with a history of suicide attempt relative to history of suicidal ideation and no suicidality (Hedge's g's Ͼ .64). Transgressions-Self was associated with significantly more severe suicidal ideation during the past week (p ϭ .018).

Due to seemingly mixed empirical results, questions persist about the possible role of deployments and combat exposure. We conducted a narrative review and meta-analysis of 22 published studies to integrate findings regarding the relationship of deployment-related predictors (i.e., deployment, deployment to a combat zone, combat experience, and exposure to specific combat events) with suicide-related outcomes (i.e., suicide ideation, attempt, and death). Across all predictors and outcomes, the combined effect was small and positive, r = .08 [0.04, 0.13], and marked by significant heterogeneity, I = 99.9%, Q(21)=4880.16, p < .0001, corresponding to a 25% increased risk for suicide-related outcomes among those who have deployed. Studies examining the relationship between exposure to killing and atrocities (k = 5) showed the largest combined effect, r = .12 [0.08, 0.17], and less heterogeneity, I = 84.4%, Q(4)=34.96, p < .0001, corresponding to a 43% increased risk for suicide-related outcomes among those exposed to killing or atrocity. Implications for theory, research, and clinical practice are discussed.

Nonsuicidal self-injury (NSSI) is a risk factor for suicide attempts, but little is known about NSSI among military personnel and veterans, or about the temporal sequencing of NSSI relative to suicide ideation and attempts. This study evaluates trajectories of suicide ideation, NSSI, and suicide attempts in a sample of 422 military personnel and veterans. Of those with a history of NSSI, 77% also experienced suicide ideation. Suicide ideation emerged before NSSI (67%) more often than the reverse (17%). Of those with a history of suicide attempt, 41% also engaged in NSSI. NSSI emerged prior to the first suicide attempt (91%) more often than the reverse (9%). The length of time from suicide ideation to suicide attempt was longer for those who first engaged in NSSI (median = 3.5 years) compared with those who did not engage in NSSI (median = 0.0 years), Wald χ(2)(1) = 11.985, p = .002. Age of onset was earlier for participants reporting NSSI only compared with those reporting both NSSI and suicide attempts (16.71 vs. 22.08 years), F(1, 45) = 4.149, p = .048. NSSI may serve as a "stepping stone" from suicide ideation to attempts for 41% of those who attempt suicide.

Purpose The purpose of this study was to identify leading sources of stress, describe rates of mental health outcomes, and examine their associations among U.S. adults during the first months of the COVID‐19 pandemic. Method In a cross‐sectional, general population survey conducted from March 18 to April 4, 2020, U.S. adults (n=10,625) were recruited through Qualtrics Panels using quota sampling methods. Results Life stressors, probable depression, past‐month suicide ideation, and past‐month suicide attempts were not elevated among participants subject to state‐level stay‐at‐home orders and/or large gatherings bans. Multiple life stressors were associated with increased rates of probable depression. Past‐month suicide ideation was significantly higher among participants reporting ongoing arguments with a partner and serious legal problems. Past‐month suicide attempt was significantly higher among participants reporting concerns about a life‐threatening illness or injury, but was significantly lower among participants reporting an unexpected bill or expense. Conclusions Results failed to support the conclusion that physical distancing measures are correlated with worse mental health outcomes. Concerns about life‐threatening illness or injury was uniquely associated with increased risk of suicide attempt.

Limited research has focused on protective factors associated with decreased suicide risk among military personnel and veterans. Self-forgiveness, defined as "the act of generosity and kindness toward the self following self-perceived inappropriate action," may be associated with decreased risk for suicide ideation and attempts, but few studies have examined this relationship. In a sample of 476 military personnel and veterans enrolled in college classes, self-forgiveness was associated with significantly less severe posttraumatic stress symptoms (␤ ϭ Ϫ.131, p ϭ .001) and was lowest among those participants who had made a suicide attempt, F(2, 435) ϭ 26.861, p Ͻ .001. Results of multinomial logistic regression indicated that self-forgiveness did not significantly differentiate participants with a history of suicide ideation from those who had never been suicidal (AOR ϭ 1.03, p ϭ .750), but self-forgiveness significantly differentiated participants who had attempted suicide from those who had only considered suicide (AOR ϭ 1.08, p ϭ .048). Self-forgiveness did not moderate the effects of posttraumatic stress on either suicide ideation or suicide attempts. Results suggest self-forgiveness may reduce risk for suicide attempts among military personnel and veterans with a history of suicide ideation.