Anger and suicidality in veterans: Impact of postseparation time and combat.

Abstract

Objective: The study investigated the association over time between the rates of anger/hostility and suicidality in post-9/11 veterans as a function of time following separation from the military and combat exposure. Method: Structured clinical interviews were conducted with N = 2,580 Iraq/Afghanistan-era U.S. military veterans serving since 9/11/01. For each participant, a postseparation interval was calculated as the time between military separation and the clinical interview, with a range of up to 9 years. Combat exposure was assessed using a three-level categorical proxy derived from the Combat Exposure Scale indexing levels of none, below, and above median exposure. Three separate estimates measuring anger/hostility and three separate measures of suicidality were modeled variously across separation intervals and levels of combat exposure. Results: In bivariate analyses, higher levels of combat exposure were associated with overall significantly higher levels of both anger/hostility and suicidality. Based on multivariable analyses, rates in measures indexing suicidality among veterans did not decrease as a function of the number of years postseparation. In contrast, rates in measures indexing anger/hostility among veterans endorsing above-median levels of combat exposure decreased significantly with increasing time since separation. Nonetheless, even at longer time points, both suicidality and anger/hostility remained elevated among respondents endorsing above-median combat exposure. Conclusions: These findings illustrate the importance of implementing suicide prevention and anger management programs for postseparation adjustment as well as for the period beyond the immediate postseparation, with particular attention paid to the level of combat exposure experienced. Clinical Impact StatementUsing multiple indices in a post-9/11 cohort, we observed that anger/hostility and suicidality were elevated among veterans endorsing high levels of combat exposure. Examining time since separation after military service, we found that measures indexing anger and hostility were decreased in cohorts sampled at longer postseparation intervals. In contrast, suicidality did not diminish among veterans at longer postseparation intervals. Results suggest treatment for anger/hostility and suicidality is critical for postseparation adjustment and emotional well-being and that efforts should extend beyond the immediate postseparation period.