Veterans who had higher killing experiences in the Vietnam War had twice the odds of suicidal ideation compared with those with lower or no killing experiences, according to study results.
Shira Maguen, PhD, of the University of California, San Francisco, and colleagues performed a cross-sectional, retrospective study of a nationally representative sample of 1.3 million Vietnam veterans from the National Vietnam Veterans Readjustment Study.
Combat experiences were measured using a 36-item scale assessing a variety of war-related experiences such as how frequently respondents saw Americans being killed or injured and exposure to explosives. The researchers derived a measure of killing experiences by creating four component variables: killing enemy, killing prisoners, killing civilians and direct involvement in killing or injuring women, children or elderly. Suicidal ideation and suicide attempts were indexed through self-reports. Veterans were also screened for depression, posttraumatic stress disorder (PTSD) and substance use disorder.
Even after adjusting for demographic variables, PTSD, substance use disorders, depression and adjusted combat exposure, researchers found that veterans who had higher killing experiences had twice the odds of suicidal ideation (OR=1.99; 95% CI, 1.07-3.67). PTSD (OR=3.42; 95% CI, 1.09-10.73), substance use disorders (OR=3.98; 95% CI, 1.01-15.60) and depression (OR=11.49; 95% CI, 2.21-62.38) were associated with higher odds of suicidal ideation compared with those with lower or no killing experiences. Results also showed that endorsement of suicide attempts was most strongly associated with PTSD (OR=5.52; 95% CI, 1.21-25.29).
According to the researchers, the United States military has lost more troops to suicide than to combat for the second year in a row. The results from the study further highlight the need to provide support for combat veterans, they said.
“This finding has important implications for the evaluation and treatment of veterans who are troubled by killing in war, and may assist with better understanding the growing public health problem of suicide in our newly returning veterans,” they wrote.
Disclosure: The study was supported by the VA Health Services Research and Development Career Development Award. The researchers report no relevant financial disclosures.