Shira Maguen1,2, Brandon J Griffin3,4, Dawne Vogt5,6, Claire A Hoffmire7,8, John R Blosnich9,10, Paul A Bernhard11, Fatema Z Akhtar11, Yasmin S Cypel11, Aaron I Schneiderman11. 1. San Francisco VA Healthcare System, San Francisco, CA, USA. 2. University of California - San Francisco, San Francisco, CA, USA. 3. Central Arkansas VA Healthcare System, Little Rock, AR, USA. 4. University of Arkansas for Medical Sciences, Little Rock, AR, USA. 5. VA Boston Healthcare System, Boston, MA, USA. 6. Boston University School of Medicine, Boston, MA, USA. 7. VA Eastern Colorado Health Care System, Aurora, Colorado, USA. 8. University of Colorado School of Medicine, Aurora, Colorado, USA. 9. University of Southern California, Los Angeles, CA, USA. 10. VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. 11. Health Outcomes of Military Exposures, Epidemiology Program, Office of Patient Care Services, Veterans Health Administration, Washington, DC, USA.
Abstract
BACKGROUND: Our goal was to examine the association between moral injury, mental health, and suicide attempts during military service and after separation by gender in post-9/11 veterans. METHODS: A nationally representative sample of 14057 veterans completed a cross-sectional survey. To examine associations of exposure to potentially morally injurious events (PMIEs; witnessing, perpetrating, and betrayal) and suicidal self-directed violence, we estimated two series of multivariable logistic regressions stratified by gender, with peri- and post-military suicide attempt as the dependent variables. RESULTS: PMIE exposure accounted for additional risk of suicide attempt during and after military service after controlling for demographic and military characteristics, current mental health status, and pre-military history of suicidal ideation and attempt. Men who endorsed PMIE exposure by perpetration were 50% more likely to attempt suicide during service and twice as likely to attempt suicide after separating from service. Men who endorsed betrayal were nearly twice as likely to attempt suicide during service; however, this association attenuated to non-significance after separation in the fully adjusted models. In contrast, women who endorsed betrayal were over 50% more likely to attempt suicide during service and after separation; PMIE exposure by perpetration did not significantly predict suicide attempts before or after service among women in the fully adjusted models. CONCLUSIONS: Our findings indicate that suicide assessment and prevention programs should consider the impact of moral injury and attend to gender differences in this risk factor in order to provide the most comprehensive care.
BACKGROUND: Our goal was to examine the association between moral injury, mental health, and suicide attempts during military service and after separation by gender in post-9/11 veterans. METHODS: A nationally representative sample of 14057 veterans completed a cross-sectional survey. To examine associations of exposure to potentially morally injurious events (PMIEs; witnessing, perpetrating, and betrayal) and suicidal self-directed violence, we estimated two series of multivariable logistic regressions stratified by gender, with peri- and post-military suicide attempt as the dependent variables. RESULTS: PMIE exposure accounted for additional risk of suicide attempt during and after military service after controlling for demographic and military characteristics, current mental health status, and pre-military history of suicidal ideation and attempt. Men who endorsed PMIE exposure by perpetration were 50% more likely to attempt suicide during service and twice as likely to attempt suicide after separating from service. Men who endorsed betrayal were nearly twice as likely to attempt suicide during service; however, this association attenuated to non-significance after separation in the fully adjusted models. In contrast, women who endorsed betrayal were over 50% more likely to attempt suicide during service and after separation; PMIE exposure by perpetration did not significantly predict suicide attempts before or after service among women in the fully adjusted models. CONCLUSIONS: Our findings indicate that suicide assessment and prevention programs should consider the impact of moral injury and attend to gender differences in this risk factor in order to provide the most comprehensive care.
Entities:
Keywords:
Suicide; depression; military; moral injury; posttraumatic stress disorder; veteran
Authors: Lauren M Borges; Sean M Barnes; Jacob K Farnsworth; Kent D Drescher; Robyn D Walser Journal: Front Psychiatry Date: 2022-06-30 Impact factor: 5.435