Suicide among war veterans

Factors of suicide-related behaviors based on stress-vulnerability model and prevention strategies among nurses: a scoping review

Objective

The objective of this scoping review was to explore, appraise and synthesize the current literature regarding the incidence, factors influencing, and prevention strategies related to suicide risk among nurses.

Methods

An extensive literature search was conducted using databases such as PubMed, Web of Science, Medline, and Embase from its formation to June 20, 2024, specifically focusing on the suicide-related behaviors of nurses written in Chinese or English. Two researchers independently screened the literature, and disagreements were debated until a consensus was reached. Data extraction was conducted for the studies that were included. The process of data synthesis was carried out using narrative analysis.

Results

The study encompassed 40 papers from 15 different countries. This study found that nurses' suicide ideation ranged from 4.3 to 44.58%, while suicide attempts ranged from 2.9 to 12.6%. Based on the stress-vulnerability model, factors influencing nurses' suicide-related behaviors include vulnerability (personality traits, coping styles), stressors (mental disorders, workplace bullying, etc.) and protective factors (social support, resilience, etc.). The strategies for preventing nurse suicide encompass primary prevention (for all nurses), secondary prevention (for nurses at risk of suicide), and tertiary prevention (for nurses who have attempted suicide).

Conclusion

The suicide rate among nurses exceeds that of the general population. Mental disorders and workplace bullying are significant stressors that contribute to nurse suicide. Suicide-related behaviors among nurses can be effectively prevented and managed through the implementation of the tertiary prevention strategies. Primary prevention is essential in reducing suicide. Cognitive exercises and schedule shifts reasonably are primary preventive measures tailored for nurses. This study addresses the gaps in influencing factors about suicide-related behaviors among nurses and the strategies for preventing suicide, and provides a complete review of the current situation of nurses' suicide-related behaviors, providing references for the safe management of nurses' suicide.

An overview of the literature on assistance dogs using text mining and topic analysis

It is said that dogs are human's best friend. On occasion, dogs can be raised and trained to provide additional specific benefits to humans suffering from a range of physical or mental conditions, working as assistance dogs. In this article, we employed innovative techniques to review the vast and constantly expanding literature on the subject, which covers a multitude of aspects. The 450 articles obtained through keyword search on Scopus were initially described in terms of year of publication, geographical context and publication destination, and were subsequently analysed through automated text mining to detect the most important words contained within them. Lastly, a generative model of topic analysis (Latent Dirichlet Allocation-LDA) described the content of the collection of documents, dividing it into the appropriate number of topics. The results yielded interesting insights across all domains, demonstrating the potential of automated text mining and topic analysis as a useful tool to support the researchers in dealing with complex and time-consuming subjects' reviews, integrating the work done with traditional reviewing methods.

'One Is Too Many' preventing self-harm and suicide in military veterans: a quantitative evaluation

INTRODUCTION

In 2021, the Armed Forces Covenant Fund Trust allocated over £2 million to programmes designed to have a clear and demonstrable impact on suicide prevention. Four grant holders delivered a combination of psychotherapeutic interventions, group activities, social prescribing, peer support mentoring, life skills coaching, educational courses and practical help with housing and employment. The evaluation was completed between August 2021 and July 2023.

METHODS

A survey was completed by 503 participants at entry and 423 at exit. It captured data regarding demographic and military-specific details, health status, situational stressors, predisposing symptoms, help-seeking behaviour, social engagement, housing, living arrangements and employment status. The questionnaire included a number of validated psychometric questionnaires.

RESULTS

This evaluation revealed reductions in situational stressors, symptoms and mental health illnesses. Seventy-six per cent of participants had completed an Operational Tour, and 77% were exposed to a traumatic event during service. It was the negative impact of unresolved traumatic effects that influenced service-users to require support. Forty-nine per cent delayed seeking help, and 36% self-referred to the One Is Too Many programme which demonstrates the importance of this option. There were improvements in the participants' social networking, social activities, club membership and having people to rely on. Only 4% of participants were women which reinforces the requirement to explore initiatives to engage with female veterans.

CONCLUSIONS

Timely therapeutic and social prescribing interventions in a safe environment lowered depression, anxiety and the associated situational stressors leading to self-harming and may have reduced suicide. It presented another option to veterans and their families regarding where they can obtain support, care and therapeutic interventions. The programme provided a strong foundation for delivery organisations to forge lasting collaborative partnerships that can be extended to working with other authorities and institutes. The results highlight pathways for prevention and intervention strategies to inform policymakers, healthcare professionals and third-sector organisations.

Prevalence and risk factors of suicide and suicidal ideation in veterans who served in the British Armed Forces: a systematic review

INTRODUCTION

Research into the factors resulting in suicide in the military veteran population has yet to reach a consensus. Available research is concentrated on a small number of countries, and there is a lack of consistency with contradictory conclusions. The USA has produced a significant amount of research in a country where suicide is identified as a national health crisis, but in the UK, there is little research regarding veterans from the British Armed Forces.

METHODS

This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Corresponding literature searches were conducted in PsychINFO, MEDLINE and CINAHL. Articles that discussed suicide, suicidal ideation, prevalence or risk factors among British Armed Forces veterans were eligible for review. A total of 10 articles met the inclusion criteria and were analysed.

RESULTS

Veterans' suicide rates were found to be comparable to those of the general UK population. The method of suicide used was most commonly found to be hanging and strangulation. Firearms was recorded in 2% of suicide cases. Demographic risk factors were often contradictory with some research stating that there was risk in older veterans and some in younger. However, female veterans were found to be at higher risk than female civilians. Those who had deployed on combat operations were at lower risk of suicide, with research finding that veterans who took longer to seek help for mental health (MH) difficulties reported more suicidal ideation.

CONCLUSIONS

Peer-reviewed research publications have revealed that UK veteran suicide prevalence is broadly comparable to the general population while highlighting differences across international armed forces. Veteran demographics, service history, transition and MH have all been identified as potential risk factors of suicide and suicidal ideation. Research has also indicated that female veterans are at higher risk than that of their civilian counterparts due to veterans being predominantly male; this could skew results and requires investigation. Current research is limited and further exploration of suicide prevalence and risk factors in the UK veteran population is required.

Risk factors for suicide in the Vietnam-era twin registry

BACKGROUND

The risk of suicide among Veterans is of major concern, particularly among those who experienced a combat deployment and/or have a history of PTSD.

DESIGN AND METHODS

This was a retrospective cohort study of post-discharge suicide among Vietnam-era Veterans who are members of the Vietnam Era Twin (VET) Registry. The VET Registry is a national sample of male twins from all branches of the military, both of whom served on active duty between 1964 and 1975. Military service and demographic factors were available from the military records. Service in-theater was based on military records; combat exposure and PTSD symptoms were assessed in 1987 by questionnaire. Mortality follow-up, from discharge to 2016, is identified from Department of Veterans Affairs, Social Security Administration, and National Death Index records; suicide as a cause of death is based on the International Classification of Death diagnostic codes from the death certificate. Statistical analysis used Cox proportional hazards regression to estimate the association of Vietnam-theater service, combat exposure, and PTSD symptoms with suicide while adjusting for military service and demographic confounding factors.

RESULTS

From the 14,401 twins in the VET Registry, there were 147 suicide deaths during follow-up. In adjusted analyses, twins who served in the Vietnam theater were at similar risk of post-discharge suicide compared with non-theater Veterans; there was no association between combat and suicide. An increase in severity of PTSD symptoms was significantly associated with an increased risk of suicide in adjusted analyses (hazard ratio = 1.13 per five-point increase in symptom score; 95% CI: 1.02-1.27).

CONCLUSIONS

Service in the Vietnam theater is not associated with greater risk of suicide; however, PTSD symptom severity poses a degree of risk of suicide in Vietnam-era Veterans. Adequate screening for PTSD in Veterans may be promising to identify Veterans who are at increased risk of suicide.

Comparing psychosocial functioning, suicide risk, and nonsuicidal self-injury between veterans with probable posttraumatic stress disorder and alcohol use disorder

BACKGROUND

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are each common among Unites States (U.S.) military veterans and frequently co-occur (i.e., PTSD+AUD). Although comorbid PTSD+AUD is generally associated with worse outcomes relative to either diagnosis alone, some studies suggest the added burden of comorbid PTSD+AUD is greater relative to AUD-alone than to PTSD-alone. Furthermore, nonsuicidal self-injury (NSSI) is more common among veterans than previously thought but rarely measured as a veteran psychiatric health outcome. This study sought to replicate and extend previous work by comparing psychosocial functioning, suicide risk, and NSSI among veterans screening positive for PTSD, AUD, comorbid PTSD+AUD, and neither disorder.

METHODS

This study analyzed data from a national sample of N = 1046 U.S. veterans who had served during the Gulf War. Participants self-reported sociodemographic, functioning, and clinical information through a mailed survey.

RESULTS

Veterans with probable PTSD+AUD reported worse psychosocial functioning across multiple domains compared to veterans with probable AUD, but only worse functioning related to controlling violent behavior when compared to veterans with probable PTSD. Veterans with probable PTSD+AUD reported greater suicidal ideation and NSSI than veterans with probable AUD, but fewer prior suicide attempts than veterans with probable PTSD.

LIMITATIONS

This study was cross-sectional, relied on self-report, did not verify clinical diagnoses, and may not generalize to veterans of other military conflicts.

CONCLUSIONS

Findings underscore the adverse psychiatric and functional outcomes associated with PTSD and comorbid PTSD+AUD, such as NSSI, and highlight the importance of delivering evidence-based treatment to this veteran population.

Resilience to Suicidal Ideation Among U.S. Military Veterans with Posttraumatic Stress: Results from the National Health and Resilience in Veterans Study

Veterans with combat exposure experience high rates of posttraumatic stress symptoms (PTSS) and associated suicidal ideation. The current study examined whether social support (i.e., social connectedness and social engagement) and protective psychological factors (i.e., resilience and altruism) moderated the relation between PTSS and suicidal ideation severity in a sample of 149 U.S. military combat veterans who served in the Vietnam War or Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND). Consistent with expectations, initial PTSS were positively associated with concurrent and three-year follow-up severity of suicidal ideation. Moderation analyses revealed the relation between initial PTSS and concurrent suicidal ideation severity was no longer significant at above average levels of social connectedness, social engagement, and psychological resilience. Further, the relation between initial PTSS and suicidal ideation severity three years later continued to be buffered by above average levels of social engagement. Results suggest social connectedness, psychological resilience, and social engagement help moderate initial severe thoughts of suicide linked to PTSS, while social engagement might be the strongest protective factor against severe suicidal ideation over time. Empirically-supported prevention and treatment efforts enhancing social engagement may help promote resilience to severe PTSS-related suicidal ideation among veterans from Vietnam and OEF/OIF/OND combat eras.

Intimate Relationships Buffer Suicidality in National Guard Service Members: A Longitudinal Study

OBJECTIVE

Members of the U.S. military are at a high suicide risk. While studies have examined predictors of suicide in the U.S. military, more studies are needed which examine protective factors for suicide. Informed by the interpersonal theory of suicide, this study examined the strength of the intimate relationship and its role as a buffer of suicidality in National Guard service members.

METHOD

A total of 712 National Guard residing in a Midwestern state, who had all recently returned home from a deployment, took part in this study and completed surveys at 6 and 12 months postdeployment. They were assessed on suicide risk, mental health (depression, post-traumatic stress disorder, anxiety), and relationship satisfaction.

RESULTS

Lower relationship satisfaction and more depressive symptoms at the 6-month assessment were significantly related to greater suicide risk at 12 months. Each interaction between couple satisfaction and three mental health variables (PTSD, depression, and anxiety) at the 6-month assessment was significantly associated with suicide risk at 12 months.

CONCLUSIONS

The strength of the intimate relationship serves as a buffer for suicide in National Guard service members who have PTSD, anxiety, or depression. Interventions that strengthen these intimate relationships could reduce suicide in service members.

Suicidal ideation in military veterans with alcohol dependence and PTSD: The role of hostility

BACKGROUND AND OBJECTIVES

Suicide is a significant public health problem among US military Veterans with rates exceeding civilian samples. Alcohol dependence (AD) and posttraumatic stress disorder (PTSD) are both associated with increases in suicidality. Given that risk of suicide is higher among those with both disorders, the study of relevant risk factors among those in this group is important. The current investigation focused on one such factor, hostility, and examined both overt hostility (ie, hostility that is more behavioral in nature and directed outwardly) and covert hostility (ie, hostility that is cognitive in nature and introspective) and their relationships to suicidal ideation.

METHODS

Ninety-three Veterans participating in a randomized, double-blind, placebo-controlled treatment study evaluating the efficacy of the alpha-adrenergic agonist prazosin completed measures assessing overt hostility, covert hostility, and suicidal ideation at baseline. Depression symptoms and PTSD symptom severity also were assessed.

RESULTS

Of the total sample, 60 participants (63.8%) indicated that they experienced suicidal ideation at some point in their lives. Covert hostility, in addition to PTSD symptom severity were found to be associated with the presence of lifetime suicidal ideation. Furthermore, depression symptoms were found to be associated with greater intensity of that ideation.

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

Findings highlight the importance of covert hostility as it relates to suicidal ideation among those with comorbid PTSD and AD and provides information which may help inform treatment approaches for high-risk military Veterans. (Am J Addict 2018;27:124-130).

Service dog training programs for veterans with PTSD: results of a pilot controlled study

Service dog programs are increasingly being explored as complementary or alternative interventions for military veterans with posttraumatic stress disorder (PTSD). This paper details the results of a control group, pre-and-post pilot investigation evaluating the use of a 14-week service dog training program for veterans in central Florida. Thirty veterans diagnosed with PTSD, 15 in the intervention group and 15 in the waitlist controlled group, completed all pretests and posttests measures, consisting of the 136-item Trauma Symptom Inventory-2 and the 36-item World Health Organization-Disability Assessment Schedule 2.0. Compared to demographically similar veterans in the control group, participants who completed the service dog training program demonstrated significant decreases in posttraumatic symptomatology, intra/interpersonal difficulties associated with psychological trauma, and in disabilities secondary to their PTSD. Study findings, in combination with results from two other recently published controlled investigations, provide evidence supporting the endorsement and use of service dog programs as helpful complementary or alternative treatment options for some veterans. Social work practitioners may want to consider referring their veteran clients with PTSD to qualified service dog programs for adjunctive support when they are having difficulty engaging with or benefiting from office-based traditional therapy approaches.

The influence of deployment stress and life stress on Post-Traumatic Stress Disorder (PTSD) diagnosis among military personnel

There is increasing recognition that traumatic stress encountered throughout life, including those prior to military service, can put individuals at increased risk for developing Posttraumatic Stress Disorder (PTSD). The purpose of this study was to examine the association of both traumatic stress encountered during deployment, and traumatic stress over one's lifetime on probable PTSD diagnosis. Probable PTSD diagnosis was compared between military personnel deployed in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF; N = 21,499) and those who have recently enlisted (N = 55,814), using data obtained from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Probable PTSD diagnosis was assessed using the PTSD Checklist. The effect of exposure to multiple types (i.e. diversity) of traumatic stress and the total quantity (i.e. cumulative) of traumatic stress on probable PTSD diagnosis was also compared. Military personnel who had been deployed experienced higher rates of PTSD symptoms than new soldiers. Diversity of lifetime traumatic stress predicted probable PTSD diagnosis in both groups, whereas cumulative lifetime traumatic stress only predicted probable PTSD for those who had been deployed. For deployed soldiers, having been exposed to various types of traumatic stress during deployment predicted probable PTSD diagnosis, but cumulative deployment-related traumatic stress did not. Similarly, the total quantity of traumatic stress (i.e. cumulative lifetime traumatic stress) did not predict probable PTSD diagnosis among new soldiers. Together, traumatic stress over one's lifetime is a predictor of probable PTSD for veterans, as much as traumatic stress encountered during war. Clinicians treating military personnel with PTSD should be aware of the impact of traumatic stress beyond what occurs during war.

Gender Differences in Suicidal Behaviors: Mediation Role of Psychological Distress Between Alcohol Abuse/Dependence and Suicidal Behaviors

Suicide is the second leading cause of death among emerging adults ages 18 to 25.

AIMS

To examine gender differences on the mediation effect of psychological distress between alcohol abuse or dependence (AAD) and suicidal behaviors (ideation, plan, and attempt).

METHOD

The current study used the 2014 NSDUH public use data. Young adults aged 18 to 25 years (M = 21.02) old were selected as study participants. The three outcome variables were suicide ideation, plan, and attempt. AAD was an independent variable. As a mediation variable, psychological distress was used to test the research questions. The mediation effect was tested by using bootstrapping methods with the SPSS version of the macro (PROCESS version 2.16) developed by Preacher and Hayes.

RESULTS

Six separate mediation analyses (three for a male and three for a female group) were conducted for different types of suicidal behaviors including ideation, plan, and attempt. Overall, psychological distress mediated the association between AAD and suicidal behaviors, except the relationship between AAD and suicide attempts among the male young adults group.

CONCLUSIONS

The findings of the current study provide specific directions for practitioners to reduce suicide rates among young adults who are at risk for suicidal behavior.

Total and cause-specific mortality of Finnish military personnel following service in international peacekeeping operations 1990-2010: a comprehensive register-based cohort study

OBJECTIVES

To estimate total and cause-specific mortality after international peacekeeping deployments among the Finnish military peacekeeping personnel in comparison to the general population of similar age and sex.

DESIGN

A register-based study of a cohort of military peacekeeping personnel in 1990-2010 followed for mortality until the end of 2013. Causes of death were obtained from the national Causes of Death Register. The standardised mortality ratio (SMR) for total and cause-specific mortality was calculated as the ratio of observed and expected number of deaths.

SETTING

Finland (peacekeeping operations in different countries in Africa, Asia and in an area of former Yugoslavia in Europe).

PARTICIPANTS

14 584 men and 418 women who had participated in international military peacekeeping operations ending between 1990 and 2010.

INTERVENTIONS

Participation in military peacekeeping operations.

MAIN OUTCOME

Total and cause-specific mortality.

RESULTS

209 men and 3 women died after their peacekeeping service. The SMR for all-cause mortality was 0.55 (95% CI 0.48 to 0.62). For the male peacekeeping personnel, the SMR for all diseases was 0.44 (95% CI 0.35 to 0.53) and for accidental and violent deaths 0.69 (95% CI 0.57 to 0.82). The SMR for suicides was 0.71 (95% CI 0.53 to 0.92).

CONCLUSIONS

Even though military peacekeeping personnel are working in unique and often stressful conditions, their mortality after their service is lower compared with the general population. Military peacekeeping personnel appear to be a selected population group with low general mortality and no excess risk of any cause of death after peacekeeping service.

California Veterans Receive Inadequate Treatment to Address their Mental Health Needs

Data from the 2011 to 2013 California Health Interview Survey (CHIS) were pooled to estimate prevalence of mental health need (serious psychological distress and impairment in one or more life domains), minimally adequate treatment (having four or more visits with a health professional in the past 12 months and use of prescription medication for mental health problems in the past 12 months), and suicide ideation among veterans living in California. Numbers and percentages were weighted to the CA population using a large sample size (N=6,952), and for comparison purposes, veterans and nonveterans were standardized to the age and gender distribution of veterans in the sample. Although differences in mental health need were similar between veterans and nonveterans after adjustment, over three-quarters of veterans did not receive minimally adequate treatment needed to address their mental health needs. Suicide ideation was significantly higher among veterans than nonveterans. Male veterans at all ages were more vulnerable to thinking about suicide compared to their nonveteran counterparts.

Negative perceptions of ageing predict the onset and persistence of depression and anxiety: Findings from a prospective analysis of the Irish Longitudinal Study on Ageing (TILDA)

BACKGROUND

Although there is a growing literature on the adverse health outcomes related with negative ageing perceptions, studies on their association with mental disorders such as depression and anxiety are scarce. Thus, the aim of the current study was to prospectively assess the association between negative ageing perceptions and incident/persistent depression and anxiety using nationally representative data from Ireland.

METHODS

Data from two consecutive waves of the Irish Longitudinal Study on Ageing (TILDA) were analysed. The analytical sample consisted of 6095 adults aged ≥50 years. Validated scales for negative ageing perceptions, depression, and anxiety were used. Multivariable logistic regression analyses were used to assess the association between negative ageing perceptions at baseline and the onset and persistence of depression and anxiety at two-year follow up.

RESULTS

After adjusting for potential confounders, negative ageing perceptions at baseline predicted the new onset of depression and anxiety at follow-up. Among those with depression or anxiety at baseline, negative ageing perceptions also predicted the persistence of these conditions at follow-up.

LIMITATIONS

Baseline data on negative ageing perceptions were used for the analysis and it is possible that scores could have changed over time.

CONCLUSIONS

Addressing negative perceptions towards ageing by developing interventions that activate positive ageing perceptions, and target societal attitudes by means of policy change, public campaigns, and community education programmes, may shift social perceptions and reduce the burden of depression and anxiety among the elderly.

Unmet Mental Healthcare Need and Suicidal Ideation Among U.S. Veterans

INTRODUCTION

Suicide prevention remains a national priority, especially among vulnerable populations. With increasing trends in suicide among Veterans, understanding the underlying factors associated with such an outcome is imperative. In this study, the association between unmet mental healthcare need and suicidal ideation among U.S. Veterans was evaluated.

METHODS

The National Survey on Drug Use and Health, 2008-2013, was used to identify those with mental illness, resulting in a total sample of 2,015 Veterans. Data were analyzed in July 2015. Survey-weighted descriptive and logistic regression analyses were conducted with p<0.05 used to establish significance.

RESULTS

Sixteen percent of Veterans reported unmet mental healthcare need and 18% had past-year suicidal ideation. After adjusting for confounders, unmet mental healthcare need was associated with increased likelihood of suicidal ideation (AOR=4.11) in the study population. Other characteristics, such as participating in a governmental assistance program and alcohol dependency in the past year, demonstrated 66% and 103% increased odds of suicidal ideation, respectively.

CONCLUSIONS

Unmet mental healthcare need is a critical aspect of suicidal ideation among Veterans. Improved access to care for such at-risk populations through means of integrated care is needed to ensure reduced burden of suicide among Veterans.

Advancing the Pain Agenda in the Veteran Population

The Veterans Health Administration (VHA) provides medical care for Veterans after leaving the military. The combination of multiple deployments and battlefield exposures to physical and psychological trauma results in a higher prevalence and complexity of chronic pain in Veterans than in the general public. The VHA and the Department of Defense work together to develop a single standard of stepped pain management appropriate for all settings from moment of injury or disease onset. This article describes the education, academic detailing, and clinical programs and policies that are transforming pain care in the VHA.

The Mental Health Status of California Veterans

Data from the California Health Interview Survey (CHIS) from 2011--2013 showed approximately 90,000 veterans had mental health needs and 200,000 reported serious thoughts of suicide during the 12 months prior to participating in CHIS. Although the proportion of veterans reporting mental health need or serious psychological distress was no higher than the general population, California veterans were more likely to report lifetime suicide ideation. This policy brief uses CHIS data to examine the mental health status, needs, and barriers to care among veterans in California. Veterans were more likely to receive mental health or substance use treatment than nonveterans, yet three of four veterans with mental health needs received either inadequate or no mental health care. Integrating mental and physical health services, increasing access to care, retaining veterans who seek mental health treatment, and reducing stigma are among the strategies that might improve the mental health of California's veterans.

Suicidal behavior and spiritual functioning in a sample of Veterans diagnosed with PTSD

Background:

Spiritual well-being has been lauded to exert a protective effect against suicidal behavior. This study examines the characteristics of spiritual functioning and their association with a self-reported history of suicidal thoughts and behavior in a sample of Veterans being treated for post-traumatic stress disorder (PTSD).

Methods:

The sample includes 472 Veterans admitted to a PTSD Residential Rehabilitation Program. Measures included the Brief Multidimensional Measure of Religiousness and Spirituality, PTSD Checklist – Military Version, Combat Experiences Scale, and individual items pertaining to history of suicidal thoughts and attempts, spiritual practices, and select demographics.

Results:

Problems with forgiveness and negative religious coping were uniquely associated with suicide risk, above and beyond age, gender, or ethnicity, combat exposure, and severity of PTSD symptomatology. Organizational religiousness was associated with decreased risk for thinking about suicide in the presence of these covariates. Daily spiritual experiences were inversely associated with suicidal thoughts. Differences in spirituality factors did not distinguish Veterans with both suicidal ideation and prior attempts from those who had ideations absent any prior attempts.

Conclusions:

The findings suggest that enhanced or diminished spiritual functioning is associated with suicidal thoughts and attempts among Veterans dealing with PTSD.

Lower prevalence of psychiatric conditions when negative age stereotypes are resisted

Older military veterans are at greater risk for psychiatric disorders than same-aged non-veterans. However, little is known about factors that may protect older veterans from developing these disorders. We considered whether an association exists between the potentially stress-reducing factor of resistance to negative age stereotypes and lower prevalence of the following outcomes among older veterans: suicidal ideation, anxiety, and posttraumatic stress disorder (PTSD). Participants consisted of 2031 veterans, aged 55 or older, who were drawn from the National Health and Resilience in Veterans Study, a nationally representative survey of American veterans. The prevalence of all three outcomes was found to be significantly lower among participants who fully resisted negative age stereotypes, compared to those who fully accepted them: suicidal ideation, 5.0% vs. 30.1%; anxiety, 3.6% vs. 34.9%; and PTSD, 2.0% vs. 18.5%, respectively. The associations followed a graded linear pattern and persisted after adjustment for relevant covariates, including age, combat experience, personality, and physical health. These findings suggest that developing resistance to negative age stereotypes could provide older individuals with a path to greater mental health.