Examining the relation between posttraumatic stress disorder and suicidal ideation in an OEF/OIF veteran sample

Abstract

This study examined the relation between posttraumatic stress disorder (PTSD) and suicidal ideation among U.S. military veterans deployed during Operation Enduring Freedom and/or Operation Iraqi Freedom. Specific aims included investigation of (1) whether PTSD was associated with suicidal ideation after controlling for combat exposure and history of suicide attempt(s), (2) whether PTSD was associated with suicidal ideation absent a co-occurring depressive disorder (MDD) or alcohol use disorder (AUD), (3) whether co-occurring MDD or AUD increased risk of suicidal ideation among those with PTSD, and (4) whether PTSD/MDD symptom clusters were differentially associated with suicidal ideation. Results pointed to unique effects associated with prior suicide attempt(s), PTSD, and MDD. PTSD-diagnosed participants with co-occurring MDD or AUD were not significantly more likely to endorse suicidal ideation than PTSD-diagnosed participants without such comorbidity. The ‘emotional numbing’ cluster of PTSD symptoms and the ‘cognitive-affective’ cluster of MDD symptoms were uniquely associated with suicidal ideation.

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

“…This finding is consistent with our hypotheses, which were based on prior research that suggested that comorbid substance-use disorders added relatively little incremental risk for suicidality over and above PTSD among veterans (Jakupcak et al, 2009;Guerra et al, 2011). While additional research is needed to replicate and expand upon these findings, our results suggest that the distress factor (i.e., PTSD and depression) of psychiatric comorbidity may be a significant risk factor for both suicidality and violence among returning Iraq/Afghanistan veterans and could help to explain the cooccurrence of these important outcomes.…”

“…A cut-off score of 3 or higher (Brown et al, 2000;Guerra et al, 2011) was used to categorize participants on suicidality (0 = no suicidality; 1 = suicidality present), as previous research has demonstrated that psychiatric outpatients who scored 3 or higher on the BSI were approximately seven times more likely than psychiatric outpatients who scored 2 or lower on the BSI to actually commit suicide during a 20-year prospective study (Brown et al, 2000). Approximately 8.5% of veterans were classified as having current suicidality using this approach.…”

Risk for suicidal behaviors associated with PTSD, depression, and their comorbidity in the U.S. Army

“…Thirty-four percent had depression, which is similar to rates of 23-31% found in other military samples using a version of the CES-D (Hankin et al, 1999;Harbertson et al, 2013). Among those with PTSD, 90% had comorbid depression, compared with comorbid depression rates of 46-56% in prior military samples (Calabrese et al, 2011;Guerra et al, 2011;Maguen et al, 2012a). The rate of comorbid depression in the current study is somewhat higher than what has been previously found.…”

“…Although there is one large-scale study of predictors of suicidality in the United States Army currently underway (Gilman et al, in press; Kessler et al, in press; Nock et al, in press; Schoenbaum et al, in press), there are no nationally representative surveys of the relationship between PTSD, depression, and suicidality in the active duty component of the U.S. Army. In the current study, 6% of service members reported past-year suicidal ideation or suicide attempts, whereas 10-12% of respondents reported lifetime or current suicidal ideation in samples of National Guard members and veterans (Calabrese et al, 2011;Guerra et al, 2011). Twelve percent of our U.S. Army sample had PTSD, comparable to previous reports of 11-20% in other military samples (Bray et al, 2010;Hankin et al, 1999;Thomas et al, 2010).…”

“…Among individuals who attempt suicide, 39-62% have a depressive disorder diagnosis (Beautrais et al, 1996;Kessler et al, 2005;Petronis et al, 1990). Although there are some data available on the association between depression and suicidality in military samples (Bryan et al, 2013;Bush et al, 2011;Goodwin et al, 2013;Guerra et al, 2011), most of these studies are limited to inpatient, veteran, or other non-representative samples of the U.S. military.…”