Publication year
2016
Citation Title
Does reintegration stress contribute to suicidal ideation among returning veterans seeking PTSD treatment?
Journal Name
Suicide and Life-Threatening Behavior
Journal Volume
46
Issue Number
2
Page Numbers
160-171
DOI
10.1111/sltb.12181
Summary
High rates of suicide during reintegration to civilian life among OEF/OIF/OND Veterans suggest that this is a time of particularly high stress. Associations between reintegration difficulties, suicidal ideation, and symptoms of posttraumatic stress disorder (PTSD), depression, and substance misuse were examined. Findings suggest that difficulty reintegrating to civilian life puts Veterans at risk for suicidal ideation above and beyond the risk of mental health symptoms.
Key Findings
Suicidal ideation was related to greater symptoms of PTSD, depression, and reintegration stress.
Difficulty reintegrating to civilian life significantly predicted greater suicidal ideation after controlling for PTSD and was marginally associated after controlling for depression.
Suicidal ideation was related to substance misuse only at high levels of reintegration stress.
Stressors that increased risk for suicidal ideation included difficulty maintaining military friendships, relationships with relatives, belonging in civilian society, and finding meaning in life.
Implications for Program Leaders
Educate military families about signs and symptoms of suicidal ideation
Provide training for military families on available resources and preventative action for individuals at risk for suicide
Offer workshops to help Service members manage stressors related to reintegrating to civilian life
Implications for Policy Makers
Promote reintegration programs that attend to Service members’ potential suicidal ideation
Recommend partnerships among military-based programs and community help hotlines for the prevention of suicide among Service members, particularly during reintegration to civilian life
Recommend training of service providers on the unique stressors for military families during the Service member’s reintegration to civilian life
Methods
All OEF/OIF/OND Veterans presenting to the San Diego Veterans Affairs (VA) department for assessment or treatment were recruited for the current study.
All data were collected via self-report questionnaires completed by participating Veterans.
Associations between difficulties reintegrating to civilian life, suicidal ideation, and mental health symptoms were examined.
Participants
The sample included 232 OEF/OIF/OND Veterans who were primarily male (95%), had an average age of 33.63 (SD = 8.34) years, and had complete questionnaire data.
Veterans identified as primarily White (38%), Latino (21%), Black (20%), or Asian-American (11%).
The sample included Veterans from the Navy (35%), Marines (32%), Army (30%), Air Force (2%), and National Guard (1%).
Limitations
The cross-sectional design of the study does not allow for examining the direction of effects of difficulty reintegrating into civilian life, suicidal ideation, and mental health symptoms.
The measure of suicidal ideation used did not distinguish between passive and potentially imminent suicidal ideation symptoms.
Participants included only Veterans seeking treatment in the VA and may not generalize to Veterans who do not seek treatment or who seek treatment outside the VA.
Avenues for Future Research
Conduct a longitudinal study to assess the effects of stressors related to reintegrating to civilian life, suicidal ideation, and mental health symptoms on one another across time
Examine which factors, especially reintegration stressors, are strongly related to potentially imminent suicidal ideation or suicide attempts as compared to passive suicidal ideation
Investigate the effect of family social support on suicidal ideation during reintegration to civilian life
Focus
Multiple Branches
Target Population
Population Focus
Military Component
Abstract
Although posttraumatic stress disorder (PTSD) and other psychiatric symptoms are well-established risk factors for suicidal ideation among returning veterans, less attention has been paid to whether the stress of reintegrating into civilian society contributes to suicidal ideation. Utilizing a sample of 232 returning veterans (95% male, mean age = 33.63 years) seeking PTSD treatment, this study tested whether reintegration difficulties contribute to suicidal ideation over and above the influence of PTSD symptoms, depression symptoms, and potential substance misuse. Logistic regressions indicated that reintegration stress had a unique effect on suicidal ideation over and above PTSD and depression symptoms. Reintegration stress interacted with substance misuse to predict suicidal ideation, such that the effect of reintegration stress on suicidal ideation was much larger for those with potential substance misuse. Exploratory analyses also examined which types of reintegration difficulties were associated with suicidal ideation, and found that difficulty maintaining military friendships, difficulty getting along with relatives, difficulty feeling like you belong in civilian society, and difficulty finding meaning/purpose in life were all significantly associated with suicidal ideation, beyond the effects of psychiatric symptoms and potential substance misuse. Findings highlight the importance of addressing reintegration stress for the prevention of suicide among returning veterans. Implications for treatment are discussed.
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