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Veterans have an elevated suicide rate, and the U.S. military now loses more troops to suicide than in combat. Depression, post-traumatic stress disorder (PTSD), and substance use disorders are major risk factors for suicide in veterans. This study focused on whether combat experiences, particularly killing in combat, independently increase risk for suicidal ideation or attempts.
The investigators examined data on 259 male Vietnam veterans who had been interviewed in the National Vietnam Veterans Readjustment Study (mean age at interview, 41 years; completion of at least some college, 55%; ethnicity: black, 13%; Hispanic, 7%; white or other, 80%). At interview, almost 14% of participants had PTSD and 4% had depression. Forty participants reported suicidal ideation, and 12 reported suicide attempts.
Veterans with suicidal ideation were significantly more likely than suicide attempters to have PTSD, depression, substance use disorders, and more experiences of killing the enemy, prisoners, and/or civilians. However, the groups did not differ in amount of other combat experience. After analyses were adjusted for demographic variables, diagnoses, and combat experience, killing experience was independently associated with a twofold risk of suicidal ideation. Only PTSD was significantly associated with suicide attempts.
Maguen S et al. Killing in combat may be independently associated with suicidal ideation. Depress Anxiety 2012 Apr 13; [e-pub ahead of print]. (http://dx.doi.org/10.1002/da.21954)
Comment
This study highlights both the importance of killing experiences in suicidal ideation in veterans and the need for clinicians to assess such experiences, their meaning, and their psychological aftermath in soldiers and returning veterans. The authors caution that this must be done sensitively and within a sound therapeutic relationship. These data also underscore the strong association between PTSD and suicide attempts.