Killing in Combat May Be Independently Associated With Suicidal Ideation

Abstract

Background The United States military has lost more troops to suicide than to combat for the second year in a row and better understanding combat‐related risk factors for suicide is critical. We examined the association of killing and suicide among war veterans after accounting for PTSD, depression, and substance use disorders. Methods We utilized a cross‐sectional, retrospective, nationally representative sample of Vietnam veterans from the National Vietnam Veterans Readjustment Study (NVVRS). In order to perform a more in depth analysis, we utilized a subsample of these data, the NVVRS Clinical Interview Sample (CIS), which is representative of 1.3 million veterans who were eligible for the clinical interview by virtue of living in proximity to an interview site, located within 28 standard metropolitan regions throughout the United States. Results Veterans who had higher killing experiences had twice the odds of suicidal ideation, compared to those with lower or no killing experiences (OR = 1.99, 95% CI = 1.07–3.67), even after adjusting for demographic variables, PTSD, depression, substance use disorders, and adjusted combat exposure. PTSD (OR = 3.42, 95% CI = 1.09–10.73), depression (OR = 11.49, 95% CI = 2.12–62.38), and substance use disorders (OR = 3.98, 95% CI = 1.01–15.60) were each associated with higher odds of suicidal ideation. Endorsement of suicide attempts was most strongly associated with PTSD (OR = 5.52, 95% CI = 1.21–25.29). Conclusions Killing experiences are not routinely examined when assessing suicide risk. Our findings have important implications for conducting suicide risk assessments in veterans of war. Depression and Anxiety 00:1–6, 2012. © 2012 Wiley Periodicals, Inc.

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

“…Prior investigations in military samples have been conducted with small, treatment-seeking samples of active duty soldiers or veterans. Among these studies, some have found an independent association of PTSD and suicidality (Bush et al, 2011;Maguen et al, 2012b), and others have not (Bryan and Corso, 2011;Bryan et al, 2013;Griffith, 2012;Richardson et al, 2012). The results of this study are similar to those of large, epidemiological studies of civilian populations (Bernal et al, 2007;Bolton and Robinson, 2010;Nock et al, 2009Sareen et al, 2007) and underscore the importance of PTSD to future suicide risk in Army soldiers.…”

“…In previous studies, similarly increased risks associated with PTSD have been reported (Calabrese et al, 2011;Guerra et al, 2011). Having PTSD was associated with three times the likelihood of reporting suicidality even after adjusting for depression, similar to prior research findings using military samples (Bush et al, 2011;Maguen et al, 2012b). Having both PTSD and depression were associated with a significantly greater risk of past-year suicidality than having either PTSD or depression alone.…”

“…Among military samples, the contribution of PTSD to suicidality above and beyond that of depression has been examined in only a few studies (Bryan and Corso, 2011;Bryan et al, 2013;Griffith, 2012;Maguen et al, 2012b;Richardson et al, 2012). Among these studies, there have been conflicting findings with regard to whether there is a significant independent association between PTSD and suicidality.…”

Veterans’ Perspectives on the Psychosocial Impact of Killing in War

“…Recent research also shows a strong association between killing in combat and suicidal ideation for both Iraq and Vietnam era veterans (Maguen et al, 2011(Maguen et al, , 2012Rice & Sher, 2013).…”

Understanding the Role of Chaplains in Veteran Suicide Prevention Efforts

“…Moral injury is representative of the challenge of having to reconcile certain wartime experiences with individual interpretations of right and wrong and is purported to increase the risk of suicide in some Veteran populations (Kohlberg, 1973;Litz et al, 2009;Maguen et al, 2012). Interpretations of right and wrong may draw on individual experiences related to religion and/or spirituality.…”