Elsevier

Journal of Affective Disorders

Volume 150, Issue 3, 25 September 2013, Pages 1226-1229
Journal of Affective Disorders

Brief report
Age and belongingness moderate the effects of combat exposure on suicidal ideation among active duty Air Force personnel

https://doi.org/10.1016/j.jad.2013.05.087Get rights and content

Abstract

Objective

To determine if intensity of combat exposure relates to suicidal ideation among active duty Air Force personnel according to age and perceived belonging.

Method

Self-report measures of suicidal ideation, combat exposure (e.g., firing weapons, being fired upon), aftermath exposure (e.g., seeing dead bodies and devastation), emotional distress, belongingness, and perceived burdensomeness were completed by 273 (81.7% male; 67.8% Caucasian, 20.5% African American, 2.2% Native American,.7% Asian,.4% Pacific Islander, and 8.4% “other”; age M=25.99, SD=5.90) active duty Air Force Security Forces personnel. Multiple regression modeling was utilized to test the associations of combat exposure and aftermath exposure with recent suicidal ideation.

Results

A significant age-by-combat exposure interaction was found (B=0.014, SE=0.006, p=0.019), suggesting combat exposure and suicidal ideation was strongest among military personnel above the age of 34. The age-by-aftermath exposure interaction was not significant (B=−0.003, SE=0.004, p=0.460). A significant three-way interaction of age, combat exposure, and belongingness was also found (B=0.011, SE=0.005, p=0.042). The Johnson–Neyman test indicated that suicidal ideation was most severe among Airmen above the age of 29 years with high combat exposure and low levels of belongingness.

Limitations

Cross-sectional, self-report design limited to two Air Force units.

Conclusions

A strong sense of belonging protects against suicidal ideation among Airmen above the age of 29 years who have been exposed to higher levels of combat.

Introduction

During the past decade, suicide has become a leading cause of death among U.S. military personnel (Department of Defense, 2010). One proposed explanation for this trend is increased combat exposure, although studies to date exploring the link between combat exposure and suicidal thoughts and behaviors have yielded mixed results. Several studies suggest an association of various dimensions of combat exposure with suicidal ideation (Fontana et al., 1992, Maguen et al., 2012, Rudd, in press, Thoresen and Mehlum, 2008), while others have failed to support a relationship (Bryan et al., 2013), or have suggested that the onset of new suicidal ideation following combat deployments is rare (Griffith, 2012) and occurs just about as often among deployed U.S. personnel who experienced combat as compared to those who did not experience combat (Griffith and Vaitkus, 2013). Yet another study with Canadian military personnel suggests that combat was not associated with increased risk for suicidal ideation, but the witnessing of atrocities was (Sareen et al., 2007).

One factor that might account for these differential results is age. Studies reporting samples with mean ages above 30 years (Fontana et al., 1992, Maguen et al., 2012, Rudd, in press, Thoresen and Mehlum, 2008) tend to find significant effects, whereas studies reporting samples with mean ages less than 30 years (Bryan et al., 2013; Griffith, 2012; Sareen et al., 2007) do not. To date, however, no studies have explicitly tested the potential moderating effect of age on the relationship of combat exposure and suicidal ideation. Furthermore, few studies have investigated protective factors associated with reduced suicide risk among military personnel exposed to combat, such as belonging, which negatively correlates with suicidal ideation among military personnel (Bryan, 2011, Thoresen and Mehlum, 2008) and is a common factor associated with military suicide attempts (Bryan et al., 2012). Belongingness may therefore be an important protective factor for military personnel with more intense combat experience.

The primary hypotheses of the current study were that combat exposure would be associated with suicidal ideation among older military personnel (i.e., a moderating effect of age on combat exposure and suicidal ideation), and that a stronger sense of belongingness would weaken the association of combat exposure with suicide attempts and severity of suicidal ideation (i.e., a moderating effect of belongingness on combat exposure and suicidal ideation).

Section snippets

Participants

Participants included 273 (81.7% male, 18.3% female) active duty US Air Force Security Forces personnel ranging in age from 19 to 50 years (M=25.99, SD=5.90) with a mean of 6.44 (SD=5.37; range: 1–26) years of military service. Race distribution was 67.8% Caucasian, 20.5% African American, 2.2% Native American,.7% Asian,.4% Pacific Islander, and 8.4% “other.” Fifteen percent of Airmen endorsed Hispanic ethnicity. Rank distribution was 47.9% junior enlisted (E3 and E4), 37.9% noncommissioned

Results

Six (2.2%) Airmen reported attempting suicide at least once during their lives and 39 (14.3%) reported recent suicidal ideation, with BSSI total scores ranging from 0 to 22 (M=0.49, SD=2.40). Combat exposure scores ranged from 0 to 20 (M=4.39, SD=4.05) and aftermath scores ranged from 1 to 15 (M=5.23, SD=4.51). Means, standard deviations, and intercorrelations of variables are presented in Table 1.

Discussion

Results of the current study suggest that the intensity of combat exposure is more strongly associated with severity of suicidal ideation as age increased, especially among Airmen above the age of 34. The interaction of combat exposure and age remained significant even when controlling for other suicide risk factors such as gender, emotional distress, past suicide attempts, and perceived burdensomeness. In contrast to combat exposure, intensity of aftermath exposure did not have as strong a

Conflict of interest

Craig Bryan has received grant funding from the Department of Defense and the Department of the Air Force, provides consultation to the Department of Defense regarding psychological health and suicide prevention, and is on the speaker's bureau for CMI Education. Mary McNaughton-Cassill and Augustine Osman do not have any actual or potential conflicts of interest.

Role of funding source

This study was supported by a grant to Craig J. Bryan from the San Antonio Life Sciences Institute (SALSI).

Acknowledgment

The authors would like to acknowledge the contributions and assistance of Lt. Col. Julia Sundstrom.

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