Leo Sher, M.D.

A research report, “Examination of the indirect effects of combat exposure on suicidal behavior in veterans” has been published in the Journal of Affective Disorders (1). The authors examined whether combat exposure has a significant indirect effect on suicidal behavior among Iraq/Afghanistan-era veterans through its effects on PTSD-depressive symptomatology.

To be eligible for inclusion, veterans must have served in the U.S. Armed Forces after September 11, 2001. In all, 3,238 veterans were included in the study. 79.7% of study participants were males. Direct and indirect relationships between three variables: combat exposure, PTSD-depression, and suicidal behavior were examined using structural equation modeling. Suicidal behavior was defined as past attempts and current ideation, intent, and preparation.

The authors found that combat experience was significantly associated with PTSD-depression, which was in turn associated with suicidal behavior. The indirect effect between combat experience and suicidal behavior was statistically significant. The authors suggest that the results of their research work indicate that the association between combat exposure and suicidal behavior is complex and may comprise multiple pathways.

Reference

1. Dillon KH, Cunningham KC, Neal JM, Wilson SM, Dedert EA, Elbogen EB, Calhoun PS, Beckham JC; VA Mid-Atlantic MIRECC Workgroup, Kimbrel NA. Examination of the indirect effects of combat exposure on suicidal behavior in veterans. J Affect Disord. 2018 Apr 11;235:407-413. doi: 10.1016/j.jad.2018.04.031.