title: Nature and determinants of suicidal ideation among U.S. veterans: Results from the national health and resilience in veterans study.
abstract: BACKGROUND
  Suicidal thoughts and behaviors among U.S. military veterans are a major public health concern. To date, however, scarce data are available regarding the nature and correlates of suicidal ideation (SI) among U.S. veterans. This study evaluated the prevalence and correlates of suicidal ideation in a contemporary, nationally representative, 2-year prospective cohort study.
  
  
  METHODS
  Data were analysed from a total of 2157 U.S. veterans who participated in the National Health and Resilience Veterans Study (NHRVS; Wave 1 conducted in 2011; Wave 2 in 2013). Veterans completed measures assessing SI, sociodemographic characteristics, and potential risk and protective correlates.
  
  
  RESULTS
  The majority of veterans (86.3%) denied SI at either time point, 5.0% had SI onset (no SI at Wave 1, SI at Wave 2), 4.9% chronic SI (SI at Waves 1 and 2), and 3.8% had remitted SI (SI at Wave 1, no SI Wave 2). Greater Wave 1 psychiatric distress was associated with increased likelihood of chronic SI (relative risk ratio [RRR]=3.72), remitted SI (RRR=3.38), SI onset (RRR=1.48); greater Wave 1 physical health difficulties were additionally associated with chronic SI (RRR=1.64) and SI onset (RRR=1.47); and Wave 1 substance abuse history was associated with chronic SI (RRR 1.57). Greater protective psychosocial characteristics (e.g., resilience, gratitude) at Wave 1 were negatively related to SI onset (RRR=0.57); and greater social connectedness at Wave 1, specifically perceived social support and secure attachment style, was negatively associated with SI onset (RRR=0.75) and remitted SI (RRR=0.44), respectively.
  
  
  CONCLUSIONS
  Suicidal ideation was assessed using a past two-week timeframe, and the limited duration of follow-up precludes conclusions regarding more dynamic changes in SI over time.
  
  
  CONCLUSIONS
  These results indicate that a significant minority (13.7%) of U.S. veterans has chronic, onset, or remitted SI. Prevention and treatment efforts designed to mitigate psychiatric and physical health difficulties, and bolster social connectedness and protective psychosocial characteristics may help mitigate risk for SI.
authors.affiliation: U.S. Department of Veterans Affairs National Center for PTSD , VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA. Electronic address: Noelle.smith2@va.gov.
authors.forename: Noelle B
authors.initials: NB
authors.lastname: Smith
authors.affiliation: U.S. Department of Veterans Affairs National Center for PTSD , VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Mota
authors.affiliation: Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; New England Mental Illness, Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, CT, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Tsai
authors.affiliation: Denver VA Medical Center, Rocky Mountain MIRECC, Denver, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Monteith
authors.affiliation: U.S. Department of Veterans Affairs National Center for PTSD , VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Northeast Program Evaluation Center, West Haven, CT, USA.
authors.forename: Ilan
authors.initials: I
authors.lastname: Harpaz-Rotem
authors.affiliation: U.S. Department of Veterans Affairs National Center for PTSD , VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Southwick
authors.affiliation: U.S. Department of Veterans Affairs National Center for PTSD , VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pietrzak
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D065840:Protective Factors; D055500:Resilience, Psychological; D012944:Social Support; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology*; D059020:Suicidal Ideation; D014481:United States; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Longitudinal time points; Nationally representative veteran sample; Protective and risk factors; Suicidal ideation