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

Post‐traumatic symptom severity mediates the association between combat exposure and suicidal ideation in veterans

“…Using three assessment time points (baseline, 6‐month follow‐up, and 12‐month follow‐up), results from a mediation model supported the hypothesis that combat exposure indirectly affects suicidal ideation via trauma‐related symptoms (severity of current PTSD symptoms). This finding adds new evidence to the growing number of cross‐sectional studies implicating mental health symptom severity as an important mechanism by which combat exposure exerts its effect on suicidal ideation (e.g., Dillon et al, 2018; Maguen et al, 2011). This is the first study, to our knowledge, to test the mediating effects of current PTSD symptoms using a longitudinal design.…”

“…The CES is a 7‐item self‐report measure in which respondents rate items on a 5‐point Likert scale (1 to 5) reflecting frequency, duration, or degree of loss of combat exposure. The CES has been used in other research with post‐9/11 era veterans and demonstrated good internal consistency (α = 0.88; Dillon et al, 2018). Similarly, for the current sample, internal consistency for the CES at baseline was 0.85.…”

“…Dillon and colleagues (2018) examined the relationship between combat exposure and suicidal thoughts and attempts in a cross‐sectional sample of post‐9/11 era veterans and found that combat exposure was indirectly related to suicidal ideation and attempts via a PTSD/depression latent variable. The results are in line with prior research showing a strong association between trauma‐related distress and suicidal thoughts and attempts (Kimbrel et al, 2014; Kimbrel, Meyer, DeBeer, Gulliver, & Morissette, 2016).…”

“…These results also support the fluid vulnerability theory, suggesting that combat exposure may be a distal predictor of suicidal ideation via increased post‐traumatic symptom severity, a more proximal risk factor. The results from the study by Dillon and colleagues (2018) were informative, but were limited by the fact that the study was cross‐sectional, making it impossible to determine the temporal direction of the relationships.…”

Nonpharmacological Treatment of Army Service Members with Chronic Pain Is Associated with Fewer Adverse Outcomes After Transition to the Veterans Health Administration

“…Also, service members with more combat exposure during their deployments are at higher risk for suicidal behavior. 39,40 While our analyses accounted for covariates of combat exposure (e.g., TBI and PTSD), we did not control for combat exposure itself. It is possible that combat exposure was not balanced between the NPT and No-NPT group, thus potentially affecting the observed associations between NPT and suicide ideation, and selfinflicted injuries in our study.…”