Risk factors of suicidal behaviors in ahigh‐risklongitudinal veteran sample: A network analysis

Abstract

Introduction: Suicide is a substantial public health burden, particularly among veterans. Risk factors have been delineated for suicide; however, the dynamic interrelations between risk factors have not been fully examined. Such research has the potential to elucidate processes that contribute to suicide risk between individuals with a past suicide attempt (attempters) and those without a past suicide attempt (nonattempters). Methods:In the current study, network analysis was used to compare networks between attempters and nonattempters in a high-risk veteran sample (N = 770; M age = 32.3 years, SD = 6.8; 326 with a past suicide attempt) who were followed over 1 year. Networks were estimated to examine (1) concurrent relations of suicide risk factors at baseline and (2) predictability of prospective suicidal behavior (SB).Results: There were no differences in the overall connectivity of attempter and nonattempter networks. Perceived burdensomeness and posttraumatic stress disorder (PTSD) symptoms were most central in the attempters' network, whereas PTSD symptoms and insomnia were most central in the nonattempters' network. The risk factors prospective SB in either network. However, attempters were more likely to engage in SB over the course of the study. Conclusion:These findings highlight the difficulty in predicting who will attempt suicide.

A longitudinal network analysis of suicide risk factors among service members and veterans sampled for suicidal ideation or attempt

“…These findings partially replicate our findings from the between-subjects network, as well as prior cross-sectional work. Specifically, several past cross-sectional network analysis studies found that perceived burdensomeness (cf., ineffectiveness) was a highly central symptom (De Beurs et al, 2019;Ortiz et al, 2023;Saulnier et al, 2023;Smith et al, 2020). Further, agitation emerged as a highly central symptom in our between-subjects model.…”

“…Thoughts of killing oneself and feeling inadequate were central nodes for suicide networks among clinical outpatients and individuals with an eating disorder (Smith et al, 2020). Perceived burdensomeness was identified again as most central in a network analysis of a veteran sample with a history of suicide attempts (Saulnier et al, 2023). Among a sample of 50 individuals who met criteria for muscle dysmorphia, Ortiz, Grunewald, Forrest, and Smith (2023) conducted a comorbidity analysis of muscle dysmorphia and suicidal ideation symptoms and found that the most central suicide-related factor was feelings of burdensomeness.…”

Comparing the interactions of risk factors by method of suicide among veterans: A moderated network analysis approach.

“…To our knowledge, this is the first study to utilize network analysis to examine risk factors for death by suicide among veterans. Indeed, prior work in this area has focused almost exclusively on examining risk factors for suicidal ideation and, to a lesser extent, attempts among those with and without a previous suicide attempt (Graziano et al, 2021; Saulnier et al, 2023; Simons et al, 2019). Given research to suggest that risk factors for suicidal ideation differ from those that contribute to suicidal behavior (Klonsky & May, 2015), this represents a vital step in this line of inquiry.…”

“…Indeed, to our knowledge, only a handful of studies to date have used network analysis to examine the risk for suicide among veterans. This literature has focused almost exclusively on the risk for suicidal ideation and, to a lesser extent, attempts among those with and without a previous suicide attempt (Graziano et al, 2021; Saulnier et al, 2023; Simons et al, 2019), with findings across studies generally indicating that depression exhibits a strong and positive connection to suicidal ideation. Although important, research suggests that risk factors for suicidal ideation differ from those for suicidal outcomes (Klonsky & May, 2014; Nock et al, 2016).…”