Relationship between specific posttraumatic stress symptoms and suicidality in a sample of American veterans: A network analysis

Military veterans are at heightened risk for posttraumatic stress disorder (PTSD) and suicidality, yet the relationship between specific posttraumatic stress symptoms (PTSS) and suicidality remains understudied. This study used network analysis to explore the interconnections between PTSS and suicidality in a treatment-seeking veteran sample. The PTSD Checklist for DSM-5 (PCL-5) and the Suicidal Behaviors Questionnaire-Revised (SBQR) were used to assess 19 nodes, including 18 PTSS and one suicidality, in both partial-correlation and Bayesian networks. Key findings revealed that negative emotions, intrusive memories, loss of interest in activities, and physiological reactivity were the most central symptoms in the partial-correlation network. Bayesian analysis further identified negative emotions as the primary causal driver of pathways leading to sleep disturbances, amnesia, and suicidality. Three symptom clusters emerged: intrusion-avoidance-sleep, negative affect-externalization-suicidality, and anhedonia. Results emphasize the importance of targeting negative emotions and related symptoms to disrupt cascading effects and reduce suicidality in veterans. These findings underscore the value of network analysis in identifying clinically actionable insights, enabling more precise and transdiagnostic approaches to PTSD treatment. Future research should incorporate longitudinal designs and additional variables, such as trauma type and resilience, to refine interventions for this high-risk population.