Protective correlates of suicidality among veterans with histories of posttraumatic stress disorder and major depressive disorder: Results from the National Health and Resilience in Veterans Study

How meaning in life and vitality are associated with posttrauma outcomes: A systematic review

When confronted with a traumatic event, people may suffer from adverse posttraumatic outcomes, such as posttraumatic stress disorder (PTSD) or complex PTSD (CPTSD). Positive psychology research has shown that meaning in life and vitality are potentially correlated protective factors against negative developments following trauma exposure that can lead to PTSD or CPTSD. This systematic review aimed to synthesize global empirical research findings, emphasizing the impact of meaning in life and vitality on both PTSD and CPTSD. A search of empirical studies was performed within the Embase, Scopus, and Web of Science core collection databases, as well as PsycInfo, using the PRISMA checklist. A total of 29 studies were included after a systematic exclusion process. The collective findings from 22 studies examining meaning in life and five studies focusing on vitality revealed a consistent negative association with symptoms of PTSD. No study that explored the associations among meaning in life, vitality, and CPTSD was found. In contrast to vitality, meaning in life has been extensively studied in relation to traumatic stress worldwide, and few discrepancies in results were found. This systematic review identified the need to intensify scientific efforts in capitalizing on meaning in life as a possible target for psychological interventions, especially for trauma survivors globally, and to consider vitality as a protective factor that needs more empirical attention in relation to posttraumatic stress. Furthermore, there is a need for studies that encompass diverse target samples and employ longitudinal study design to examine the associations between protective factors and CPTSD.

What predicts personal growth following a deployment? An examination of National Guard soldiers through the lens of posttraumatic growth

National Guard soldiers experience unique reintegration challenges. In addition to managing the consequences of combat-related trauma, they also navigate multiple transitions between military and civilian life. Despite these obstacles, many soldiers report positive outcomes and personal growth due to deployment, a phenomenon most commonly referred to in the literature as posttraumatic growth (PTG). The current study explored PTG in National Guard soldiers using a multidimensional longitudinal approach, with the goal of validating reports of PTG in soldiers. Data were collected from National Guard soldiers at pre-deployment, reintegration, one year post-deployment and two years post-deployment. Informed by PTG theory, three PTG constructs were measured (perceived ability to handle stress, social support seeking, and purpose in life) at each of the four time points, with increases in these constructs indicating growth. Potential predictors of growth in these PTG constructs were also explored. Results from a repeated measure latent profile analysis indicated that PTG did occur in certain soldiers, and that higher optimism and less severe PTSD symptoms predict this growth. These findings emphasize the importance of making efforts to facilitate PTG in soldiers.

Moral injury among U.S. combat veterans with and without PTSD and depression

BACKGROUND

Questions persist about how often potentially morally injurious events (PMIEs) are associated with posttraumatic stress disorder (PTSD) and depression.

METHODS

This study examined the overlap of morally injurious events with probable PTSD and depression in a nationally representative sample of U.S. combat veterans (n = 1,321, mean age 59.1, 93.7% male).

RESULTS

Most veterans with probable PTSD (72.2%), probable depression (72.4%), and probable PTSD and/or depression (68.4%), endorsed experiencing PMIEs; 31.1-35.3% of these participants endorsed perpetration, 45.1-50.4% endorsed witnessing others, and 52.6-55.7% endorsed betrayal. The prevalence of PMIEs among veterans without current probable PTSD and/or depression was 33.7%, 32.3%, and 31.5%, respectively; 7.9-9.1% of these participants endorsed perpetration-based PMIEs, 19.2-20.3% witnessing, and 19.8-21.8% endorsed betrayal. PMIEs were more prevalent among veterans with probable PTSD or depression relative to those without (ORs ranging 2.14-3.32; p's < 0.001).

CONCLUSIONS

This is the first nationally representative study to examine the prevalence of PMIEs among veterans with and without probable PTSD or depression. Results highlight the importance of understanding distress and functional impairment in these veterans to evaluate whether they may benefit from intervention. PMIEs were strikingly more prevalent among veterans with probable PTSD and depression, suggesting that veterans without PMIEs are the minority among combat veterans with these disorders.

Psychological well-being in US veterans with non-fatal suicide attempts: A multi-cohort population-based study

BACKGROUND

Most people who survive suicide attempts neither re-attempt suicide nor die by suicide. Research on suicide attempt survivors has primarily focused on negative endpoints (e.g., increased suicide risk) rather than positive outcomes. One important outcome is psychological well-being (PWB), defined as positive functioning across emotional, intrapersonal, and interpersonal domains. We compared PWB among US military veterans with (i.e., attempt survivors) and without (i.e., non-attempters) a history of suicide attempt(s) using data from three nationally representative cohorts.

METHODS

Each US veteran cohort (Cohort1: N = 3148; Cohort2: N = 1474; Cohort3: N = 4042) completed measures of suicidality (e.g., attempt history), character strengths (e.g., curiosity, optimism), psychological symptoms (e.g., depression), and indicators of PWB (e.g., happiness). t-Tests were conducted to examine group differences in PWB; hierarchical regressions were conducted to examine suicide attempt status as a predictor of PWB controlling for symptoms and demographics. Multivariable regressions were conducted to identify predictors of PWB among attempt survivors.

RESULTS

In each cohort, reported PWB was markedly lower among suicide attempt survivors than non-attempters (ds = 0.9-1.2), even after adjusting for mental health symptoms. Individual differences in PWB were observed, with a subset of suicide attempt survivors reporting higher PWB levels than non-attempters (1.4-7.4 %). Curiosity and optimism were positively associated with PWB among suicide attempt survivors (rs = 0.60-0.78).

LIMITATIONS

Data were cross-sectional, limiting inferences about causation and directionality of associations.

CONCLUSIONS

Findings highlight diminished PWB as an important and understudied concern among veteran attempt survivors. Collectively, our findings underscore the importance of considering PWB in the research, assessment, and treatment of suicidality.

Associations of Suicide Risk and Community Integration Among Patients With Treatment-Resistant Depression

INTRODUCTION

Treatment-resistant depression (TRD) is one of the primary causes of disability and a major risk for suicide among patients living in the community. However, the suicide risks and care needs for safety among patients with TRD during the community reintegration process appear to be underestimated. This study aimed to investigate the association between community integration and suicide risks among patients with treatment-resistant depression (TRD) with sub-analysis by gender.

METHODS

Patients diagnosed with major depressive disorder were recruited upon psychiatrists' referral in two general hospitals in northern Taiwan during 2018-2019. The participants who experienced more than two failed treatments of antidepressants with partial remission were defined as TRD. A structured questionnaire was used to collect socio-demographic, suicidality, and psychosocial information.

RESULTS

In a total of 125 participants, gender difference was identified in certain community integration aspects such as home integration, productivity, and electronic social networking. The male participants appeared to have better involvement in social contact with internet but slightly less video link than women, while women had higher level of home integration in the past month. The participants who performed worse in the social integration and better home-based activity or productivity levels had higher suicide risks including suicide ideation and overall suicide risks.

CONCLUSIONS

Community integration levels of home, social, and productivity were associated with suicidality in terms of overall suicide risk and recent suicide ideation. Facilitation of community integration at home and life arrangements might reduce suicide risks in TRD patients.

Is Gratitude Associated With Suicidal Ideation in Veterans With Mental Illness and Student Veterans With PTSD Symptoms?

ABSTRACT

The present study is aimed to identify the effect of gratitude as an adaptive regulating mechanism from suicidal ideation (SI) for veterans with mental illness (study 1) and student veterans with posttraumatic stress disorder (PTSD) symptoms (study 2) in the United States. Descriptive statistics and regression analyses were used to examine sociodemographic characteristics and relationships between gratitude and SI. Our study 1 consisted of 156 veterans with mental illness. The mean age for study 1 was 37.85. Our study 2 consisted of 232 student veterans with PTSD symptoms. The mean age for study 2 was 28.43. Higher gratitude scores in study 1 and study 2 were significantly associated with lower SI scores after adjusting for demographics and depression. This study partially supports the association between gratitude and SI in veterans with mental illness. Based on the results from this study, gratitude interventions may be effective in reducing SI when working with veterans with mental illness.

Fluid vulnerability theory as a framework for understanding the association between posttraumatic stress disorder and suicide: A narrative review

Suicide is a persistent issue in the United States and across the globe. A large body of published research shows that posttraumatic stress disorder (PTSD) increases the risk of suicidal ideation, suicidal behaviors, and death by suicide. However, the existing literature examining why that association might pertain is widely dispersed across disciplines (e.g., psychology, nursing) and lacks an integrative theoretical framework, making it difficult to conceptualize the current state of science in this area. Therefore, the primary aims of this narrative review were to (a) provide a comprehensive and interdisciplinary critique of the current state of knowledge regarding mechanisms that underlie the association between PTSD and suicide and (b) organize that knowledge according to a specified theoretical framework. The framework guiding this review is "fluid vulnerability theory," a diathesis-stress model of suicide that emphasizes the dynamic nature of suicide risk across cognitive, emotional, behavioral, and physiological domains. A summary of the findings, including patterns that emerged, gaps that remain, and recommendations for the advancement of science and practice in this area are addressed in this narrative review.

The National Health and Resilience in Veterans Study: A Narrative Review and Future Directions

United States (U.S.) veterans are substantially older than their non-veteran counterparts. However, nationally representative, population-based data on the unique health needs of this population are lacking. Such data are critical to informing the design of large-scale outreach initiatives, and to ensure the effectiveness of service care delivery both within and outside of the Veterans Affairs healthcare system. The National Health and Resilience in Veterans Study (NHRVS) is a contemporary, nationally representative, prospective study of two independent cohorts (n = 3,157 and n = 1,484) of U.S. veterans, which is examining longitudinal changes, and key risk and protective factors for several health outcomes. In this narrative review, we summarize the main findings of all NHRVS studies (n = 82) published as of June 2020, and discuss the clinical implications, limitations, and future directions of this study. Review of these articles was organized into six major topic areas: post-traumatic stress disorder, suicidality, aging, resilience and post-traumatic growth, special topics relevant to veterans, and genetics and epigenetics. Collectively, results of these studies suggest that while a significant minority of veterans screen positive for mental disorders, the majority are psychologically resilient. They further suggest that prevention and treatment efforts designed to promote protective psychosocial characteristics (i.e., resilience, gratitude, purpose in life), and social connectedness (i.e., secure attachment, community integration, social engagement) help mitigate risk for mental disorders, and promote psychological resilience and post-traumatic growth in this population.

Purpose in life is a robust protective factor of reported cognitive decline among late middle-aged adults: The Emory Healthy Aging Study

BACKGROUND

Cognitive abilities tend to decline in advanced age. A novel protective factor of cognitive decline in advanced age is purpose-in-life (PiL), a trait-like tendency to derive life meanings and purpose. However, whether PiL protects against cognitive decline in late-middle-age is unclear. Hence, we examined the association between PiL and perceived cognitive decline, one of the earliest detectable cognitive symptoms before the onset of cognitive impairment. Furthermore, we used a machine learning approach to investigate whether PiL is a robust predictor of cognitive decline when considered with the known protective and risk factors for cognition.

METHODS

PiL was assessed with a 10-item questionnaire and perceived cognitive decline with the Cognitive Function Instrument among 5,441 Emory Healthy Aging Study participants, whose mean age was 63 and 51% were employed. Association between PiL and perceived cognitive decline was examined with linear regression adjusting for relevant confounding factors. Elastic Net was performed to identify the most robust predictors of cognitive decline.

RESULTS

Greater PiL was associated with less perceived cognitive decline after adjusting for the relevant factors. Furthermore, Elastic Net modeling suggested that PiL is a robust predictor of cognitive decline when considered simultaneously with known protective (education, exercise, enrichment activities) and risk factors for cognition (depression, anxiety, diagnosed medical, mental health problems, smoking, alcohol use, family history of dementia, and others).

LIMITATION

This is a cross-sectional study.

CONCLUSIONS

PiL is a robust protective factor of perceived cognitive decline observed as early as middle age. Thus, interventions to enhance PiL merit further investigation.

Purpose in Life and Conscientiousness Protect Against the Development of Suicidal Ideation in U.S. Military Veterans With PTSD and MDD: Results From the National Health and Resilience in Veterans Study

BACKGROUND

Although several studies have examined risk factors for suicidal ideation among veterans, little is known about risk and protective factors for suicidal ideation in high-risk veteran samples. Thus, this study examined a broad range of risk and protective factors associated with the development of suicidal ideation in a high-risk sample of U.S. veterans who screened positive for current posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD).

METHODS

Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative, prospective cohort study of U.S. veterans. Veterans completed self-report measures to screen for PTSD and MDD and to assess for risk and protective factors. The sample included 222 veterans with PTSD and/or MDD who did not endorse suicidal ideation at baseline and completed at least one assessment over a seven-year follow-up period. A multivariable binary logistic regression analysis was conducted to examine baseline factors associated with incident suicidal ideation.

RESULTS

Nearly one in three (27.1%) of veterans with PTSD and/or MDD developed suicidal ideation over the seven-year follow-up period. Non-Caucasian race and lower scores on measures of purpose in life, conscientiousness, and frequency of religious service attendance were independently associated with incident suicidal ideation. Lower purpose in life (52.3%) and conscientiousness (33.2%) explained the vast majority of variance in incident suicidal ideation.

CONCLUSION

Nearly 30% of veterans with PTSD and/or MDD who did not endorse suicidal ideation at baseline developed suicidal ideation over a seven-year period. Prevention and treatment efforts designed to bolster purpose in life and conscientiousness may help mitigate risk for suicidal ideation in this high-risk population.