Military Service, Depression, Belonging, and Suicidality Among College Students

<b></b> <i>Background:</i> Suicide remains a leading cause of early mortality, particularly among young adults under 35 years, with college students showing high rates of suicidal ideation and attempts. Student-veterans represent a unique group facing distinct stressors that may increase suicide risk compared to their nonmilitary counterparts. <i>Aims:</i> This study aimed to examine the relationships among military service history and suicidal ideation, planning, and attempts among college students. Specifically, this investigation tested whether depressive symptoms and feelings of belonging mediate these relationships. <i>Method:</i> To answer these questions, this study analyzed data from 119,664 respondents aged 18-45 years drawn from the 2020-2021 Healthy Minds Study, a national survey of mental health among US college students. Generalized structural equation modeling was used to test the mediating influence of depression (PHQ-9 scores) and belonging on the relationship between military service and suicide outcomes, adjusting for covariates and the complex sampling design. <i>Results:</i> Military service was significantly associated with higher levels of suicidal ideation (β = .391, 95% CI [0.095, 0.684]) and suicide planning (β = .531, 95% CI [0.123, 0.940]), but not suicide attempts (β = .637, 95% CI [-0.057, 1.360]). Depression and low belonging were strong predictors of suicidality. Indirect-effect analysis indicated that belonging was the only significant mediator of the association between military service and suicidal outcomes. <i>Limitations:</i> The limitations of this study include the cross-sectional design, self-reported data, voluntary participation of institutions, and relatively low prevalence of suicide attempts which reduced statistical power. Future longitudinal and qualitative studies are needed to validate findings and explore moderating factors. <i>Conclusion:</i> Military-affiliated college students have higher risk for suicidal ideation and planning. This relationship was partially explained by reduced feelings of belonging. Interventions to increase campus social integration among student-veterans have the potential to mitigate suicide risk in this population.