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Longitudinal courses of suicidal ideation in U.S. military veterans: a 7-year population-based, prospective cohort study

Published online by Cambridge University Press:  19 February 2021

Sarah Herzog Open the ORCID record for Sarah Herzog [Opens in a new window] ,
Jack Tsai ,
Brandon Nichter Open the ORCID record for Brandon Nichter [Opens in a new window] ,
Lorig Kachadourian ,
Ilan Harpaz-Rotem Open the ORCID record for Ilan Harpaz-Rotem [Opens in a new window]  and
Robert H. Pietrzak
Sarah Herzog*
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
Jack Tsai
Affiliation:
VA National Center on Homelessness Among Veterans, Tampa, FL, USA School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
Brandon Nichter
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
Lorig Kachadourian
Affiliation:
U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
Ilan Harpaz-Rotem
Affiliation:
U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
Robert H. Pietrzak
Affiliation:
U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
*
Author for correspondence: Sarah Herzog, E-mail: [email protected]
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Abstract

Background

Varied longitudinal courses of suicidal ideation (SI) may be linked to unique sets of risk and protective factors.

Method

A national probability sample of 2291 U.S. veterans was followed over four assessments spanning 7 years to examine how a broad range of baseline risk and protective factors predict varying courses of SI.

Results

Most veterans (82.6%) denied SI at baseline and all follow-ups, while 8.7% had new onset SI, 5.4% chronic SI, and 3.3% remitted SI. Compared to the no-SI group, chronic SI was associated with childhood trauma, baseline major depressive and/or posttraumatic stress disorder (MDD/PTSD), physical health difficulties, and recent traumatic stressors. Remitted veterans had the highest risk of a prior suicide attempt (SA) compared to no-SI [relative risk ratio (RRR) = 3.31] and chronic SI groups (RRR = 4.65); and high rates of MDD/PTSD (RRR = 7.62). New onset SI was associated with recent stressors and physical health difficulties. All symptomatic SI groups reported decrements in protective factors, specifically, social connectedness, trait curiosity/exploration, and purpose in life.

Conclusion

Nearly one-in-five veterans reported SI over a 7-year period, most of whom evidenced new onset or remitted SI courses. Chronic and remitted SI may represent particularly high-risk SI courses; the former was associated with higher rates of prospective SA, and psychiatric and physical distress, and the latter with increased likelihood of prior SA, and isolation from social and mental health supports. Physical disability, MDD/PTSD, and recent stressors may be important precipitating or maintaining factors of SI, while social connectedness may be a key target for suicide prevention efforts.

Keywords

Longitudinalrisk and protective factorssuicidal ideationsuicide attemptveterans
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 15 , November 2022 , pp. 3570 - 3579
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Copyright
Copyright © The Author(s) 2021. Published by Cambridge University Press

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