An etiological model of attempted suicide among Vietnam theater veterans. Prospective generalization to a treatment-seeking sample.

The etiology of attempted suicide was investigated using both retrospective and prospective data from 402 Vietnam theater veterans who were receiving treatment in the Department of Veterans Affairs Posttraumatic Stress Disorder Clinical Teams Program. An etiological model that was developed previously for a community sample of Vietnam theater veterans was examined for its generalizability to this treatment-seeking sample. Structural equation modeling was used to first determine the similarity of significant paths in the treatment-seeking and community samples, and then to examine the applicability of the community-based model to the treatment-seeking sample. The community-based model achieved a very high fit with reasonably good parsimony with the treatment-seeking data. Causal paths in the treatment-seeking sample mirrored those in the community sample in that psychiatric symptoms (including posttraumatic stress disorder) were the sole factors contributing directly to attempted suicide. Traumatic military experiences played a substantial role, but only indirectly as they contributed to the development of psychiatric symptoms. The similarity of findings for previous and subsequent attempts eliminated a possible ambiguity in the direction of causation modeled for previous attempts.