Suicidality and Nonsuicidal High-Risk Behavior in Military Veterans: How Does PTSD Symptom Presentation Relate to Behavioral Risk?

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Abstract

Considerable attention has been devoted to investigating posttraumatic stress disorder (PTSD) and suicidality in military veterans, but nonsuicidal high-risk behaviors (HRBs), like reckless driving, are underexplored and contribute to elevated rates of premature death in this population. This study is the 1st to employ a structural equation modeling approach to investigate relationships between PTSD symptoms, suicidality, and HRBs in veterans. Data for this study were drawn from a sample of veterans living in Southern California. A multipronged sampling strategy was used to recruit 2,422 veterans, who completed an online battery. A structural equation model examining direct and indirect effects between 4 PTSD symptom factors, a suicidality factor, and an HRB factor was fitted to the data. We found positive direct effects for reexperiencing and negative cognitive–mood symptoms on suicidality and for hyperarousal symptoms on HRBs. We found a negative direct effect for avoidance on suicidality. Suicidality demonstrated a positive direct effect on HRBs. We detected positive indirect effects for reexperiencing and negative cognitive–mood symptoms on HRBs and a negative indirect effect for avoidance on HRBs through the suicidality pathway. Results show that distinct PTSD symptom clusters are associated with different risk profiles in military veterans. High rates of HRBs with the potential for lethal outcomes evident in our sample demonstrate the need for nuanced screening procedures. Veterans who do not meet full clinical criteria for PTSD may be at risk for premature mortality from suicide and HRBs in the context of reexperiencing, negative cognitive–mood, and hyperarousal symptoms.

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