1
|
Glenn JJ, Dillon KH, Dennis PA, Patel TA, Mann AJ, Calhoun PS, Kimbrel NA, Beckham JC, Elbogen EB. Post-traumatic symptom severity mediates the association between combat exposure and suicidal ideation in veterans. Suicide Life Threat Behav 2020; 50:1167-1172. [PMID: 32770773 PMCID: PMC7746613 DOI: 10.1111/sltb.12678] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/08/2020] [Accepted: 05/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Previous studies of military veterans have produced mixed findings regarding whether combat exposure is directly related to suicidal ideation or is indirectly related to suicidal ideation via its influence on other factors. The present study used a longitudinal design to test the hypothesis that post-traumatic stress disorder (PTSD) symptom severity mediates the effect of combat exposure on suicidal ideation in veterans. METHOD Participants included 319 post-9/11 veterans (83.4% male; 42.1% White/52.1% Black; Mage = 39.7) assessed at baseline, 6, and 12 months. Structural equation modeling and bootstrapped confidence intervals were employed to examine the direct and indirect relationships between combat exposure, suicidal ideation, and PTSD symptom severity. RESULTS Results from the mediation model, in which demographic variables and non-combat trauma were included as covariates, revealed that the indirect effect of combat exposure on suicidal ideation via PTSD symptom severity was statistically significant, accounting for 64.1% of the covariance between combat exposure and suicidal ideation. CONCLUSIONS This study provides longitudinal evidence that the effects of combat exposure on suicidal ideation are mediated by PTSD symptom severity, suggesting the importance of targeting such symptoms in treatment to mitigate suicide risk among veterans with combat exposure.
Collapse
Affiliation(s)
- Jeffrey J. Glenn
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
| | - Kirsten H. Dillon
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Paul A. Dennis
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Tapan A. Patel
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
| | - Adam J. Mann
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
| | - Patrick S. Calhoun
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
- VA Center for Health Services Research in Primary Care, Durham, NC, USA
| | - Nathan A. Kimbrel
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
- VA Center for Health Services Research in Primary Care, Durham, NC, USA
| | - Jean C. Beckham
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Eric B. Elbogen
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
2
|
Fried D, McAndrew LM, Helmer DA, Markowitz S, Quigley KS. Interrelationships between symptom burden and health functioning and health care utilization among veterans with persistent physical symptoms. BMC FAMILY PRACTICE 2020; 21:124. [PMID: 32611312 PMCID: PMC7329405 DOI: 10.1186/s12875-020-01193-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 06/15/2020] [Indexed: 11/12/2022]
Abstract
Background Between 10 and 50% of primary care patients present with persistent physical symptoms (PPS). Patients with PPS tend to utilize excessive or inappropriate health care services, while being stuck in a deleterious cycle of inactivity, deconditioning, and further worsening of symptoms and disability. Since military deployment (relative to non-deployment) is associated with greater likelihood of PPS, we examined the interrelationships of health care utilization, symptom burden and functioning among a sample of recently deployed Veterans with new onset persistent physical symptoms. Methods This study analyzed a cohort of 790 U.S. soldiers who recently returned from deployment to Iraq or Afghanistan. Data for this analysis were obtained at pre- and post-deployment. We used moderation analyses to evaluate interactions between physical symptom burden and physical and mental health functioning and four types of health care utilization one-year after deployment, after adjusting for key baseline measures. Results Moderation analyses revealed significant triple interactions between physical symptom burden and health functioning and: primary care (F = 3.63 [2, 303], R2Δ = .02, p = 0.03), specialty care (F = 6.81 [2, 303] R2Δ =0.03, p < .001), allied therapy care (F = 3.76 [2, 302], R2Δ = .02, p = 0.02), but not mental health care (F = 1.82 [1, 303], R2Δ = .01, p = .16), one-year after deployment. Conclusions Among U.S. Veterans with newly emerging persistent physical symptoms one-year after deployment, increased physical symptom burden coupled with decreased physical and increased mental health functioning was associated with increased medical care use in the year after deployment. These findings support whole health initiatives aimed at improving health function/well-being, rather than merely symptom alleviation.
Collapse
Affiliation(s)
- Dennis Fried
- Department of Veterans Affairs, NJ War Related Illness & Injury Study Center, 385 Tremont Ave. Mailstop 129, East Orange, NJ, 07018, USA. .,Department of Epidemiology, Rutgers, The State University of New Jersey, 185 South Orange Avenue, MSB, Newark, NJ, 07101, USA.
| | - Lisa M McAndrew
- Department of Veterans Affairs, NJ War Related Illness & Injury Study Center, 385 Tremont Ave. Mailstop 129, East Orange, NJ, 07018, USA
| | - Drew A Helmer
- Department of Veterans Affairs, NJ War Related Illness & Injury Study Center, 385 Tremont Ave. Mailstop 129, East Orange, NJ, 07018, USA.,New Jersey Medical School, Rutgers, The State University of New Jersey, 185 South Orange Avenue, MSB, Newark, NJ, 07101, USA
| | | | - Karen S Quigley
- Interdisciplinary Affective Science Laboratory, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, USA.,Department of Veterans Affairs, Bedford Memorial Hospital, 200 Springs Rd, Bedford, MA, 01730, USA
| |
Collapse
|