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

Abstract

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.

Cannabis use disorder and suicide attempts in Iraq/Afghanistan-era veterans

“…Consistent with the findings of Borges et al (2016) and Kimbrel et al (in press), we hypothesized that CUD would be significantly associated with both current suicidal ideation and lifetime history of suicide attempts in this sample of Iraq/Afghanistan-era veterans, even after accounting for established predictors of suicidal behavior among veterans, including sex, PTSD, depression, alcohol use disorder, non-cannabis drug use disorder, history of childhood sexual abuse, and combat exposure (Ashrafioun et al, 2016; Kimbrel et al, 2014, 2015, 2016a, 2016b, in press; Maguen et al, 2015). …”

“…Procedures for this study have been fully described elsewhere (Ashley-Koch et al, 2015; Calhoun et al, 2008; Guerra et al, 2011; Kimbrel et al, 2014). To be eligible for the study, participants had to have served in the United States military after September 11, 2001.…”

“…Combat exposure was assessed with the Combat Exposure Scale (CES; Keane et al, 1989). Current suicidal ideation and lifetime history of suicide attempts were assessed with the Beck Scale for Suicide Ideation (BSS; Beck & Steer, 1991), which has demonstrated reliability and validity in previous research (Brown et al, 2000), including studies of suicidal behavior in Iraq/Afghanistan-era veterans (DeBeer et al, 2014; Guerra et al, 2011; Kimbrel et al, 2014). Scores of 3 or higher on the BSS have been prospectively associated with increased risk for death by suicide (Brown et al, 2000).…”

“…Death by suicide and suicidal behavior are major concerns among veterans at the present time [Bullman and Kang, 1994; DeBeer et al, 2014; Kang and Bullman, 2008; Kaplan, Huguet, McFarland, & Newsom, 2007; Kimbrel et al, 2014, 2015, 2016a, 2016b; U.S. Department of Veterans Affairs (VA), 2016].…”

“…Indeed, the most recent statistics available from the Department of Veterans Affairs (2016) suggest that approximately 20 veterans die by suicide each day in the United States. Considerable evidence suggests that veterans with mental health disorders, such as PTSD and depression, are at particularly high risk for suicidal behavior and death by suicide (Bullman and Kang, 1994; DeBeer et al, 2014; Kang and Bullman, 2008; Kaplan et al, 2007; Kimbrel et al, 2014, 2016a; VA, 2016); however, there has been only limited research on the association between CUD and suicidal behavior among veterans to date. In fact, we are aware of only one other study that has examined the association between CUD and suicide attempts in veterans.…”