Interactive Association of Posttraumatic Stress Disorder and Related Comorbidities with Loneliness on Suicidal Thoughts and Behavior in the Army National Guard

Abstract

Abstract The public health challenges of suicide include suicidal thoughts and behaviors (STB) such as suicidal ideation and nonfatal suicide attempts. STB precede suicide death in the ideation-to-action framework. To better understand relationships of psychiatric and psychosocial correlates of STB, this study examined associations among PTSD and related co-occurring symptoms of depression and alcohol misuse as well as their interaction with social isolation and loneliness on STB. Three hypotheses were tested in a population-based sample of 1,992 Army National Guard (ANG) members: (1) PTSD, depression, alcohol use symptom severity, and social isolation and loneliness will be associated with STB, (2) PTSD symptom severity score combined with that of depression, alcohol use, and both, will be associated with STB and explain more variation in STB than PTSD symptom severity alone, and (3) the relationship between STB and PTSD symptom severity alone and in combination with co-occurring depression and alcohol use symptom severity will be moderated by social isolation and loneliness. Notably, National Guard members face both similar and distinct stressors compared to active-duty military. Our findings suggest associations between mental health symptom severity and STB in the ANG are similar to those of the larger veteran population. Findings from the interaction analysis suggest that addressing social isolation and loneliness in the context of PTSD may decrease STB and may be especially important when PTSD symptoms are accompanied by co-occurring depressive symptoms or alcohol misuse.