Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Combat Exposure, Suicidal Behavior Linked via PTSD

J Affect Disord; ePub 2018 Apr 10; Dillon, et al

Combat exposure was indirectly related to suicidal behavior via posttraumatic stress disorder (PTSD)-depressive symptomatology, according to a recent study. Findings lend support for a higher-order combined PTSD-depression latent factor and suggest that Iraq/Afghanistan-era veterans with high levels of PTSD-depressive symptoms are at increased risk for suicidal behavior. Iraq/Afghanistan-era veterans (n=3,238) participated in a cross-sectional, multi-site study of post-deployment mental health consisting of clinical interviews and self-report questionnaires. Structural equation modeling (SEM) was used to examine direct and indirect relationships between 3 latent variables: combat exposure, PTSD-depression, and suicidal behavior (past attempts and current ideation, intent, and preparation). Researchers found:

  • Combat exposure was significantly associated with PTSD-depression (β = 0.50), which was in turn associated with suicidal behavior (β = 0.62).
  • As expected, the indirect effect between combat exposure and suicidal behavior was statistically significant, β = 0.31.


Dillon KH, Cunningham KC, Neal JM, et al. Examination of the indirect effects of combat exposure on suicidal behavior in veterans. [Published online ahead of print April 10, 2018]. J Affect Disord. doi:10.1016/j.jad.2018.04.031.