Suicidal Ideation and Suicide Risk: Differential Associations of Affective and Depressive Symptoms in Veterans Seeking Treatment for Posttraumatic Stress Disorder
By: G. Mitchell Mazzone and Ursula S. Myers
References
- Afzali, M. H., Sunderland, M., Teesson, M., Carragher, N., Mills, K., & Slade, T. (2017). A network approach to the comorbidity between posttraumatic stress disorder and major depressive disorder: The role of overlapping symptoms. Journal of Affective Disorders, 208, 490–496. 10.1016/j.jad.2016.10.037
- Albanese, B. J., Myers, U. S., Fox, H., & Wangelin, B. C. (2022). Reduced working memory performance in PTSD and suicide among veterans presenting for treatment. Journal of Psychiatric Research, 156, 299–307. 10.1016/j.jpsychires.2022.10.043
- American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing. 10.1176/appi.books.9780890425787
- Athey, A., & Overholser, J. (2018). A systematic review of suicide risk in veterans: Depression is a more powerful predictor than comorbid psychiatric disorders. Military Behavioral Health, 6(4), 368–377. 10.1080/21635781.2018.1442757
- Balázs, J., Benazzi, F., Rihmer, Z., Rihmer, A., Akiskal, K. K., & Akiskal, H. S. (2006). The close link between suicide attempts and mixed (bipolar) depression: Implications for suicide prevention. Journal of Affective Disorders, 91(2), 133–138. 10.1016/j.jad.2005.12.049
- Batterham, P. J., Ftanou, M., Pirkis, J., Brewer, J. L., Mackinnon, A. J., Beautrais, A., … & Christensen, H. (2015). A systematic review and evaluation of measures for suicidal ideation and behaviors in population-based research. Psychological Assessment, 27(2),
501 . 10.1037/pas0000053 - Blosnich, J. R., Montgomery, A. E., Dichter, M. E., Gordon, A. J., Kavalieratos, D., Taylor, L., Ketterer, B., & Bossarte, R. M. (2020). Social determinants and military veterans’ suicide ideation and attempt: A cross-sectional analysis of electronic health record data. Journal of General Internal Medicine, 35(6), 1759–1767. 10.1007/s11606-019-05447-z
- Bonanni, L., Gualtieri, F., Lester, D., Falcone, G., Nardella, A., Fiorillo, A., & Pompili, M. (2019). Can anhedonia be considered a suicide risk factor? A review of the literature. Medicina, 55(8),
458 . 10.3390/medicina55080458 - Brown, L. A., Jerud, A., Asnaani, A., Petersen, J., Zang, Y., & Foa, E. B. (2018). Changes in posttraumatic stress disorder (PTSD) and depressive symptoms over the course of prolonged exposure. Journal of Consulting and Clinical Psychology, 86(5), 452–463. 10.1037/ccp0000292
- Brown, L. A., McLean, C. P., Zang, Y., Zandberg, L., Mintz, J., Yarvis, J. S., Litz, B. T., Peterson, A. L., Bryan, C. J., Fina, B., Petersen, J., Dondanville, K. A., Roache, J. D., Young-McCaughan, S., & Foa, E. B. (2019). Does prolonged exposure increase suicide risk? Results from an active duty military sample. Behaviour Research and Therapy, 118, 87–93. 10.1016/j.brat.2019.04.003
- Bryan, C. J., Morrow, C. E., Etienne, N., & Ray-Sannerud, B. (2013). Guilt, shame, and suicidal ideation in a military outpatient clinical sample. Depression and Anxiety, 30(1), 55–60. 10.1002/da.22002
- Bullman, T., Schneiderman, A., & Gradus, J. L. (2019). Relative importance of posttraumatic stress disorder and depression in predicting risk of suicide among a cohort of Vietnam veterans. Suicide and Life-Threatening Behavior, 49(3), 838–845. 10.1111/sltb.12482
- Carter, S. P., Malte, C. A., Rojas, S. M., Hawkins, E. J., & Reger, M. A. (2020). Examination of potential disparities in suicide risk identification and follow-up care within the Veterans Health Administration. Suicide and Life-Threatening Behavior, 50(6), 1127–1139. 10.1111/sltb.12673
- Carr, E. R., Woods, A. M., Vahabzadeh, A., Sutton, C., Wittenauer, J., & Kaslow, N. J. (2013). PTSD, depressive symptoms, and suicidal ideation in African American women: A mediated model. Journal of Clinical Psychology in Medical Settings, 20(1), 37–45. 10.1007/s10880-012-9316-1
- Chen, X., Ren, L., Xue, X., Yu, N., Liu, P., Shen, W., Zhou, H., Wang, B., Zhou, J., Yang, S. & Jiang, Q. (2023). The comorbidity of depression and anxiety symptoms in tinnitus sufferers: a network analysis. Brain Sciences, 13(4),
583 . 10.3390/brainsci13040583 - Chu, C., Klein, K. M., Buchman-Schmitt, J. M., Hom, M. A., Hagan, C. R., & Joiner, T. E. (2015). Routinized assessment of suicide risk in clinical practice: An empirically informed update. Journal of Clinical Psychology, 71(12), 1186–1200. 10.1002/jclp.22210
- Conner, K. R., Bossarte, R. M., He, H., Arora, J., Lu, N., Tu, X. M., & Katz, I. R. (2014). Posttraumatic stress disorder and suicide in 5.9 million individuals receiving care in the veterans health administration health system. Journal of Affective Disorders, 166, 1–5. 10.1016/j.jad.2014.04.067
- Ducasse, D., Loas, G., Dassa, D., Gramaglia, C., Zeppegno, P., Guillaume, S., … & Courtet, P. (2018). Anhedonia is associated with suicidal ideation independently of depression: A meta-analysis. Depression and anxiety, 35(5), 382–392. 10.1002/da.22709
- Elhai, J. D., Contractor, A. A., Tamburrino, M., Fine, T. H., Prescott, M. R., Shirley, E., Chan, P. K., Slembarski, R., Liberzon, I., Galea, S., & Calabrese, J. R. (2012). The factor structure of major depression symptoms: A test of four competing models using the Patient Health Questionnaire-9. Psychiatry Research, 199(3), 169–173. 10.1016/j.psychres.2012.05.018
- Fang, X., Zhang, C., Wu, Z., Peng, D., Xia, W., Xu, J., Wang, C., Cui, L., Huang, J., & Fang, Y. (2018). The association between somatic symptoms and suicidal ideation in Chinese first-episode major depressive disorder. Journal of Affective Disorders, 245, 17–21. 10.1016/j.jad.2018.10.110
- Franklin, C. L., & Zimmerman, M. (2001). Posttraumatic stress disorder and major depressive disorder: Investigating the role of overlapping symptoms in diagnostic comorbidity. The Journal of Nervous and Mental Disease, 189(8), 548–551. 10.1097/00005053-200108000-00008
- Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., Musacchio, K. M., Jaroszewski, A. C., Chang, B. P., & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187–232. 10.1037/bul0000084
- Green, J. D., Kearns, J. C., Rosen, R. C., Keane, T. M., & Marx, B. P. (2018). Evaluating the effectiveness of safety plans for military veterans: Do safety plans tailored to veteran characteristics decrease suicide risk? Behavior Therapy, 49(6), 931–938. 10.1016/j.beth.2017.11.005
- Harris, E. C., & Brian, B. (1997). Suicide as an outcome for mental disorders. British Journal of Psychiatry, 170(3), 205–228. 10.1192/bjp.170.3.205
- Hoge, C. W., Terhakopian, A., Castro, C. A., Messer, S. C., & Engel, C. C. (2007). Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. American Journal of Psychiatry, 164(1), 150–153. 10.1176/ajp.2007.164.1.150
- Holliday, R., Borges, L. M., Stearns-Yoder, K. A., Hoffberg, A. S., Brenner, L. A., & Monteith, L. L. (2020). Posttraumatic stress disorder, suicidal ideation, and suicidal self-directed violence among U.S. military personnel and veterans: A systematic review of the literature from 2010 to 2018. Frontiers in Psychology, 11. 10.3389/fpsyg.2020.01998
- Hudson, D. L., Eaton, J., Banks, A., Sewell, W., & Neighbors, H. (2018). “Down in the Sewers”: Perceptions of depression and depression care among African American men. American journal of men’s health, 12(1), 126–137. 10.1177/1557988316654864
- Johnson, M. L., Cotler, J., Terman, J. M., & Jason, L. A. (2022). Risk factors for suicide in chronic fatigue syndrome. Death Studies, 46(3), 738–744. 10.1080/07481187.2020.1776789
- Joiner, T. (2005). Why People Die by Suicide. Harvard University Press.
- Ketcheson, F., Cyr, K., King, L., & Richardson, J. D. (2018). Influence of PTSD and MDD on somatic symptoms in treatment-seeking military members and Veterans. Journal of Military, Veteran and Family Health, 4(2), 101–109. 10.3138/jmvfh.2017-0029
- Klonsky, E. D., May, A. M., & Saffer, B. Y. (2016). Suicide, suicide attempts, and suicidal ideation. Annual Review of Clinical Psychology, 12, 307–330. 10.1146/annurev-clinpsy-021815-093204
- Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Journal of General Internal Medicine, 16(9), 606–613. 10.1046/j.1525-1497.2001.016009606.x
- Kuzmina, N., Switzer, J., Ponder, W. N., & Spencer, C. M. (2023). Affective depression mediates PTSD to suicide in sample of post-9/11 combat veterans. Journal of Veterans Studies, 9(3). 10.21061/jvs.v9i3.452
- Large, M., Corderoy, A., & McHugh, C. (2021). Is suicidal behaviour a stronger predictor of later suicide than suicidal ideation? A systematic review and meta-analysis. Australian & New Zealand Journal of Psychiatry, 55(3), 254–267. 10.1177/0004867420931161
- Martin, A., Naunton, M., Kosari, S., Peterson, G., Thomas, J., & Christenson, J. K. (2021). Treatment guidelines for PTSD: A systematic review. Journal of Clinical Medicine, 10(18), 10.3390/jcm10184175
- Martin, L. A., Neighbors, H. W., & Griffith, D. M. (2013). The experience of symptoms of depression in men vs women: Analysis of the National Comorbidity Survey Replication. JAMA Psychiatry, 70(10), 1100–1106. 10.1001/jamapsychiatry.2013.1985
- McAndrew, L. M., Lu, S. E., Phillips, L. A., Maestro, K., & Quigley, K. S. (2019). Mutual maintenance of PTSD and physical symptoms for Veterans returning from deployment. European Journal of Psychotraumatology, 10(1),
1608717 . 10.1080/20008198.2019.1608717 - McFarlane, A. C., & Graham, D. K. (2021). The ambivalence about accepting the prevalence somatic symptoms in PTSD: Is PTSD a somatic disorder? Journal of Psychiatric Research, 143, 388–394. 10.1016/j.jpsychires.2021.09.030
- McKinney, J., Hirsch, J., & Britton, P. (2017). PTSD symptoms and suicide risk in veterans: Serial indirect effects via depression and anger. ETSU Faculty Works, 214, 100–107. 10.1016/j.jad.2017.03.008
- Mendes, D. D., Mello, M. F., Ventura, P., de Medeiros Passarela, C., & de Jesus Mari, J. (2008). A systematic review on the effectiveness of cognitive behavioral therapy for posttraumatic stress disorder. The International Journal of Psychiatry in Medicine, 38(3), 241–259. 10.2190/PM.38.3.b
- Michael Vanderlind, W., Beevers, C. G., Sherman, S. M., Trujillo, L. T., McGeary, J. E., Matthews, M. D., Todd Maddox, W., & Schnyer, D. M. (2014). Sleep and sadness: Exploring the relation among sleep, cognitive control, and depressive symptoms in young adults. Sleep Medicine, 15(1), 144–149. 10.1016/j.sleep.2013.10.006
- Na, P. J., Yaramala, S. R., Kim, J. A., Kim, H., Goes, F. S., Zandi, P. P., Vande Voort, J. L., Sutor, B., Croarkin, P. & Bobo, W. V. (2018). The PHQ-9 Item 9 based screening for suicide risk: a validation study of the Patient Health Questionnaire (PHQ)– 9 Item 9 with the Columbia Suicide Severity Rating Scale (C-SSRS). Journal of Affective Disorders, 232, 34–40. 10.1016/j.jad.2018.02.045
- Nichter, B., Norman, S., Haller, M., & Pietrzak, R. H. (2019). Psychological burden of PTSD, depression, and their comorbidity in the U.S. veteran population: Suicidality, functioning, and service utilization. Journal of Affective Disorders, 256, 633–640. 10.1016/j.jad.2019.06.072
- Nichter, B., Stein, M. B., Norman, S. B., Hill, M. L., Straus, E., Haller, M., & Pietrzak, R. H. (2021). Prevalence, correlates, and treatment of suicidal behavior in US military veterans: results from the 2019–2020 National Health and Resilience in Veterans Study. Journal of Clinical Psychiatry, 82(5),
e13714 . 10.4088/JCP.20m13714 - Nock, M. K., Millner, A. J., Ross, E. L., Kennedy, C. J., Al-Suwaidi, M., Barak-Corren, Y., Castro, V. M., Castro-Ramirez, F., Lauricella, T., Murman, N., Petukhova, M., Bird, S. A., Reis, B., Smoller, J. W., & Kessler, R. C. (2022). Prediction of suicide attempts using clinician assessment, patient self-report, and electronic health records. JAMA Network Open, 5(1),
e2144373 . 10.1001/jamanetworkopen.2021.44373 - Nuij, C., Van Ballegooijen, W., De Beurs, D., Juniar, D., Erlangsen, A., Portzky, G., O’Connor, R. C., Smit, J. H., Kerkhof, A., & Riper, H. (2021). Safety planning-type interventions for suicide prevention: meta-analysis. The British Journal of Psychiatry, 219(2), 419–426. 10.1192/bjp.2021.50
- O’Brien, R. M. (2007). A Caution Regarding Rules of Thumb for Variance Inflation Factors. Quality & Quantity, 41, 673–690. 10.1007/s11135-006-9018-6
- Orri, M., Perret, L. C., Turecki, G., & Geoffroy, M.-C. (2018). Association between irritability and suicide-related outcomes across the life-course. Systematic review of both community and clinical studies. Journal of Affective Disorders, 239, 220–233. 10.1016/j.jad.2018.07.010
- Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8(4), 443–454. 10.1177/107319110100800409
- Pacella, M. L., Hruska, B., & Delahanty, D. L. (2013). The physical health consequences of PTSD and PTSD symptoms: A meta-analytic review. Journal of Anxiety Disorders, 27(1), 33–46. 10.1016/j.janxdis.2012.08.004
- Panagioti, M., Gooding, P. A., & Tarrier, N. (2012). A meta-analysis of the association between posttraumatic stress disorder and suicidality: The role of comorbid depression. Comprehensive Psychiatry, 53(7), 915–930. 10.1016/j.comppsych.2012.02.009
- Possemato, K., Wade, M., Andersen, J., & Ouimette, P. (2010). The impact of PTSD, depression, and substance use disorders on disease burden and health care utilization among OEF/OIF veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 2(3),
218 . 10.1037/a0019236 - Pfeiffer, P. N., Brandfon, S., Garcia, E., Duffy, S., Ganoczy, D., Kim, H. M., & Valenstein, M. (2014). Predictors of suicidal ideation among depressed veterans and the interpersonal theory of suicide. Journal of Affective Disorders, 152–154(1), 277–281. 10.1016/j.jad.2013.09.025
- Pigeon, W. R., Bishop, T. M., & Titus, C. E. (2016). The relationship between sleep disturbance, suicidal ideation, suicide attempts, and suicide among adults: A systematic review. Psychiatric Annals, 46(3), 177–186. 10.3928/00485713-20160128-01
- Pompili, M., Sher, L., Serafini, G., Forte, A., Innamorati, M., Dominici, G., … & Girardi, P. (2013). Posttraumatic stress disorder and suicide risk among veterans: A literature review. The Journal of Nervous and Mental Disease, 201(9), 802–812. 10.1097/nmd.0b013e3182a21458
- Ponder, W. N., Walters, K., Simons, J. S., Simons, R. M., Jetelina, K. K., & Carbajal, J. (2022). Network analysis of distress, suicidality, and resilience in a treatment seeking sample of first responders. Journal of Affective Disorders, ePub(ePub). 10.1016/j.jad.2022.09.097
- Ribeiro, J. D., Franklin, J. C., Fox, K. R., Bentley, K. H., Kleiman, E. M., Chang, B. P., & Nock, M. K. (2016). Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: A meta-analysis of longitudinal studies. Psychological Medicine, 46(2), 225–236. 10.1017/S0033291715001804
- Ribeiro, J. D., Gutierrez, P. M., Joiner, T. E., Kessler, R. C., Petukhova, M. V., Sampson, N. A., Stein, M. B., Ursano, R. J., & Nock, M. K. (2017). Health care contact and suicide risk documentation prior to suicide death: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Journal of Consulting and Clinical Psychology, 85(4), 403–408. 10.1037/ccp0000178
- Ribeiro, J. D., Huang, X., Fox, K. R., & Franklin, J. C. (2018). Depression and hopelessness as risk factors for suicide ideation, attempts and death: meta-analysis of longitudinal studies. The British Journal of Psychiatry, 212(5), 279–286. 10.1192/bjp.2018.27
- Rice, S. M., Kealy, D., Oliffe, J. L., Seidler, Z. E., & Ogrodniczuk, J. S. (2019). Affective-somatic symptoms of depression, suicide risk and exposure to childhood maltreatment: Data from emerging adults to older-age males. International Journal of Mental Health and Addiction, 17(6), 1301–1311. 10.1007/s11469-018-0045-z
- Richardson, E. J., & Richards, J. S. (2008). Factor structure of the PHQ-9 screen for depression across time since injury among persons with spinal cord injury. Rehabilitation Psychology, 53(2), 243–249. 10.1037/0090-5550.53.2.243
- Roberge, E. M., Harris, J. A., Weinstein, H. R., & Rozek, D. C. (2021). Treating veterans at risk for suicide: An examination of the safety, tolerability, and outcomes of cognitive processing therapy. Journal of Traumatic Stress, 34(6), 1228–1237. 10.1002/jts.22662
- Rotenstein, L. S., Ramos, M. A., Torre, M., Segal, J. B., Peluso, M. J., Guille, C., … & Mata, D. A. (2016). Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA, 316(21), 2214–2236. 10.1001/jama.2016.17324
- Rudd, M. D., Berman, A. L., Joiner, T. E., Nock, M. K., Silverman, M. M., Mandrusiak, M., Van Orden, K., & Witte, T. (2006). Warning Signs for suicide: Theory, research, and clinical applications. Suicide and Life-Threatening Behavior, 36(3), 255–262. 10.1521/suli.2006.36.3.255
- Rugo, K. F., Tabares, J. V., Crowell, S. E., Baucom, B. R., Rudd, M. D., & Bryan, C. J. (2020). The role of depression and suicidal cognitions as contributors to suicide risk among active duty soldiers reporting symptoms of posttraumatic stress disorder. Journal of Affective Disorders, 265, 333–341. 10.1016/j.jad.2020.01.095
- Sanchez-Gistau, V., Baeza, I., Arango, C., Gonzalez-Pinto, A., de la Serna, E., Parellada, M., … & Castro-Fornieles, J. (2012). Predictors of suicide attempt in early-onset, first-episode psychoses: a longitudinal 24-month follow-up study. The Journal of Clinical Psychiatry, 74(1), 59–66. 10.4088/jcp.12m07632
- Sareen, J., Cox, B. J., Stein, M. B., Afifi, T. O., Fleet, C., & Asmundson, G. J. G. (2007). Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosomatic Medicine, 69(3), 242–248. 10.1097/PSY.0b013e31803146d8
- Saulnier, K. G., Bagge, C. L., Ganoczy, D., Bahraini, N. H., Jagusch, J., Hosanagar, A., Ilgen, M. A., & Pfeiffer, P. N. (2025). Suicide risk evaluations and suicide in the Veterans Health Administration. JAMA Network Open, 8(2),
e2461559 . 10.1001/jamanetworkopen.2024.61559 - Schafer, K. M., Duffy, M., Kennedy, G., Stentz, L., Leon, J., Herrerias, G., Fulcher, S., & Joiner, T. E. (2022). Suicidal ideation, suicide attempts, and suicide death among Veterans and service members: A comprehensive meta-analysis of risk factors. Military Psychology.
https://www.tandfonline.com/doi/abs/10.1080/08995605.2021.1976544 - Schmidt, A. F., & Finan, C. (2018). Linear regression and the normality assumption. Journal of Clinical Epidemiology, 98, 146–151. 10.1016/j.jclinepi.2017.12.006
- Schuman, D. L., Cerel, J., & Praetorius, R. T. (2019). Suicide in U.S. women veterans: An Interpersonal Theory perspective on suicide prevention policies. Social Work in Public Health, 34(5), 418–429. 10.1080/19371918.2019.1616028
- Seidler, Z. E., Dawes, A. J., Rice, S. M., Oliffe, J. L., & Dhillon, H. M. (2016). The role of masculinity in men’s help-seeking for depression: a systematic review. Clinical Psychology Review, 49, 106–118. 10.1016/j.cpr.2016.09.002
- Senaviratna, N. A. M. R., & Cooray, T. M. J. A. (2019). Diagnosing Multicollinearity of Logistic Regression Model. Asian Journal of Probability and Statistics, 5(2), 1–9. 10.9734/ajpas/2019/v5i230132
- Sikharulidze, G., van Geloven, N., Lelashvili, E., Kalandarishvili, G., Gugushvili, N., & Vermetten, E. (2017). Posttraumatic stress disorder and somatic complaints in a deployed cohort of Georgian military personnel: Mediating effect of depression and anxiety. Journal of Traumatic Stress, 30(6), 626–634. 10.1002/jts.22235
- Soumoff, A. A., Clark, N. G., Spinks, E. A., Kemezis, P. A., Raiciulescu, S., Driscoll, M. Y., Kim, S. Y., Benedek, D. M. & Choi, K. H. (2022). Somatic symptom severity, not injury severity, predicts probable posttraumatic stress disorder and major depressive disorder in wounded service members. Journal of Traumatic Stress, 35(1), 210–221. 10.1002/jts.22722
- Sullivan, S., & Germain, M.-L. (2019). Psychosocial risks of healthcare professionals and occupational suicide. Industrial and Commercial Training, 52(1), 1–14. 10.1108/ICT-08-2019-0081
- Sun, Y., Shi, L., Bao, Y., Sun, Y., Shi, J., & Lu, L. (2018). The bidirectional relationship between sleep duration and depression in community-dwelling middle-aged and elderly individuals: Evidence from a longitudinal study. Sleep Medicine, 52, 221–229. 10.1016/j.sleep.2018.03.011
- Tegegne, K. T., Tegegne, E. T., Tessema, M. K., Bagajjo, W. S., Rike, M., Abebe, A. T., & Bifato, B. (2022). The association between depression and suicidal ideation: a systematic review and meta-analysis. J Psychol Mental Health Care, 6(1), 1–6. 10.47363/PMS/2021(5)158
- Theis, J., Hoops, K., Booty, M., Nestadt, P., & Crifasi, C. (2021). Firearm suicide among veterans of the U.S. military: A systematic review. Military Medicine, 186(5–6), e525–e536. 10.1093/milmed/usaa495
- Torres, M. E., Löwe, B., Schmitz, S., Pienta, J. N., Van Der Feltz-Cornelis, C., & Fiedorowicz, J. G. (2021). Suicide and suicidality in somatic symptom and related disorders: A systematic review. Journal of Psychosomatic Research, 140,
110290 . 10.1016/j.jpsychores.2020.110290 - Tucker, R. P. (2019). Suicide in transgender veterans: Prevalence, prevention, and implications of current policy. Perspectives on Psychological Science, 14(3), 452–468. 10.1177/1745691618812680
- U. S. Department of Veterans Affairs, Office of Mental Health and Suicide Prevention. (2023). 2023 national veteran suicide prevention annual report.
https://www.mentalhealth.va.gov/docs/data-sheets/2023/2023-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-508.pdf - Whitworth, J., Galusha, J., Carbajal, J., Ponder, W. N., & Schuman, D. L. (2023). Affective Depression mediates PTSD to suicide in a sample of treatment-seeking first responders. Journal of Occupational and Environmental Medicine, 65(3),
249 . 10.1097/JOM.0000000000002724 - Woznica, A. A., Carney, C. E., Kuo, J. R., & Moss, T. G. (2015). The insomnia and suicide link: Toward an enhanced understanding of this relationship. Sleep Medicine Reviews, 22, 37–46. 10.1016/j.smrv.2014.10.004
DOI: https://doi.org/10.21061/jvs.v12i1.883 | Journal eISSN: 2470-4768
Language: English
Page range: 172 - 184
Submitted on: Mar 20, 2026
Accepted on: Jun 16, 2026
Published on: Jul 27, 2026
Published by: Virginia Tech Publishing
In partnership with: Paradigm Publishing Services
© 2026 G. Mitchell Mazzone, Ursula S. Myers, published by Virginia Tech Publishing
This work is licensed under the Creative Commons Attribution 4.0 License.