Interpersonal and Trauma-Related Guilt moderate the relationship between intensity of combat experiences and suicidality

Suicide rates in military-affiliated communities remain elevated since the dawn of the Global War on Terror, despite substantial efforts by clinicians and researchers. While some risk factors have been identified, mixed results need to be clarified. The current study builds on previous research by testing a structural equation model of suicide risk associated with combat experiences that by incorporates risk factors with the most empirical support (combat experiences, guilt, PTSD, depression, and the Interpersonal Psychological Theory of Suicide [IPTS] factors of Perceived Burdensomeness, Thwarted Belongingness, Acquired Capability), using improved measures, in a more representative sample of Post-9/11 deployers. The models were evaluated separately for each of two different conceptualizations of guilt (trauma-related and interpersonal) as moderating factors. The results show that higher levels of guilt, whether trauma-related or interpersonal, strengthened the relationship between combat experiences and pathology. In contrast to previous studies, intensity of combat experiences was indirectly linked to suicidality through pathology and the IPTS constructs of Perceived Burdensomeness and Acquired Capability. The most prominent pathway to suicidal thoughts and behaviors in both guilt models traveled from combat experiences through PTSD and Perceived Burdensomeness, providing a clear target for clinical and organizational interventions.