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. 2020 Dec;50(6):1167-1172.
doi: 10.1111/sltb.12678. Epub 2020 Aug 8.

Post-traumatic symptom severity mediates the association between combat exposure and suicidal ideation in veterans

Jeffrey J Glenn  1   2 , Kirsten H Dillon  1   2   3 , Paul A Dennis  1   2   3 , Tapan A Patel  1   2 , Adam J Mann  1   2 , Patrick S Calhoun  1   2   3   4 , Nathan A Kimbrel  1   2   3   4 , Jean C Beckham  1   2   3 , Eric B Elbogen  1   2   3
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Free PMC article

Post-traumatic symptom severity mediates the association between combat exposure and suicidal ideation in veterans

Jeffrey J Glenn et al. Suicide Life Threat Behav. 2020 Dec.
Free PMC article

Abstract

Objective: Previous studies of military veterans have produced mixed findings regarding whether combat exposure is directly related to suicidal ideation or is indirectly related to suicidal ideation via its influence on other factors. The present study used a longitudinal design to test the hypothesis that post-traumatic stress disorder (PTSD) symptom severity mediates the effect of combat exposure on suicidal ideation in veterans.

Method: Participants included 319 post-9/11 veterans (83.4% male; 42.1% White/52.1% Black; Mage = 39.7) assessed at baseline, 6, and 12 months. Structural equation modeling and bootstrapped confidence intervals were employed to examine the direct and indirect relationships between combat exposure, suicidal ideation, and PTSD symptom severity.

Results: Results from the mediation model, in which demographic variables and non-combat trauma were included as covariates, revealed that the indirect effect of combat exposure on suicidal ideation via PTSD symptom severity was statistically significant, accounting for 64.1% of the covariance between combat exposure and suicidal ideation.

Conclusions: This study provides longitudinal evidence that the effects of combat exposure on suicidal ideation are mediated by PTSD symptom severity, suggesting the importance of targeting such symptoms in treatment to mitigate suicide risk among veterans with combat exposure.

Figures

Figure 1.
Figure 1.
Structural equation model of suicidal ideation. The total (unadjusted) and direct adjusted effect (in parentheses) of combat exposure on suicidal ideation are depicted. All effects are standardized. Covariate effects are presented in the table. The dotted line represents the mediated pathway. †p < .10, **p < .01, aFemale gender was set as the reference group. bBlack race was set as the reference group.
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