Purpose in life protects against the development of suicidal thoughts and behaviors in U.S. veterans without a history of suicidality: A 10-year, nationally representative, longitudinal study

To determine the incidence of suicidal ideation and suicide attempts (STBs) in veterans without an endorsed history of STBs and identify baseline predictors of these outcomes over a 10-year period. Population-based prospective cohort study of 2307 US military veterans using five waves of the 2011–20...

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Bibliographic Details
Published in:Journal of affective disorders 2023-11, Vol.340, p.551-554
Main Authors: Fischer, Ian C., Nichter, Brandon, Feldman, David B., Na, Peter J., Tsai, Jack, Harpaz-Rotem, Ilan, Schulenberg, Stefan E., Pietrzak, Robert H.
Format: Article
Language:English
Subjects:
Longitudinal
Purpose in life
Suicidal thoughts and behaviors
US veterans
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Summary:To determine the incidence of suicidal ideation and suicide attempts (STBs) in veterans without an endorsed history of STBs and identify baseline predictors of these outcomes over a 10-year period. Population-based prospective cohort study of 2307 US military veterans using five waves of the 2011–2021 National Health and Resilience in Veterans Study. Baseline data were collected in 2011, with follow-up assessments conducted 2-(2013), 4-(2015), 7-(2018), and 10-years (2021) later. In total, 10.1 % (N = 203) of veterans endorsed incident suicidal ideation (SI) over the 10-year period and 3.0 % (N = 55) endorsed an incident suicide attempt (SA). Multivariable regression analyses revealed the following baseline predictors of incident SI: lower annual household income, current posttraumatic stress disorder, current alcohol use disorder (AUD), disability with activities of daily living (i.e., ADLs) or instrumental activities of daily living (i.e., IADLs), lower perceived social support, lower community integration, and lower purpose in life. Current AUD, greater cumulative trauma burden, and lower purpose in life at baseline were predictive of incident SA. Relative importance analyses revealed that lower purpose in life was the strongest predictor of both incident SI and SA. Psychosocial determinants of health, such as purpose in life, may be more reliable predictors of incident suicidal thoughts and behaviors than traditional risk factors (e.g., psychiatric distress; history of SA) in those without a history of STBs. Evidence-based interventions that facilitate purpose in life and feelings of connectedness and belonging should be examined as possible treatments for STBs. •Purpose in life (PIL) may protect against the development of suicidal thoughts and behaviors (STBs) in US Veterans.•Studies documenting the association between PIL and STBs have typically relied on convenience samples, cross-sectional designs, or relatively short follow-ups.•In this 10-year study, PIL emerged as the strongest predictor of both incident suicidal ideation and suicide attempts in US Veterans.
ISSN:0165-0327
1573-2517
DOI:10.1016/j.jad.2023.08.040