(WITHDRAWN) Trajectories of Suicidal Ideation, Mental Health, and Psychosocial Functioning in Recently Returned Iraq & Afghanistan Veterans: An Investigation of Sex Differences

Background and Purpose: Suicide rates in veterans are recognized as a national health crisis and suicide prevention is the Department of Veterans Affairs’ (VA) highest clinical priority. However, there is scant longitudinal research investigating sex differences in the relationships among suicidal ideation (SI), mental health severity, and psychosocial functioning factors associated with increased suicide risk.

Objectives: Our first objective was to explore sex differences in trajectories of mental health and psychosocial factors that have been previously associated with increased suicide risk. Our second objective was to explore whether trajectories of mental health factors would longitudinally predict SI.

Method: This secondary data study investigated prospective relationships among seven suicide risk factors including SI, PTSD, depression, alcohol misuse, and three domains of psychosocial function (work, parental, and intimate relationship). Using VA data, N= 1046 post-deployment OIF/OEF veterans (n= 554 women and n= 502 men) were observed across three time-points (T1, T2, & T3) over a 7.5-year study period. Linear mixed models were used to investigate sex differences in trajectories of suicide risk factors and fixed effect binary logistic regression models were used to identify predictors of SI at T3. Separate models were fit for each risk factor while controlling for combat exposure and sexual harassment during deployment.

Results: Males and females differed on initial status of both PTSD and alcohol misuse severity, , and parental and work functioning (p< .05). Significant sex by time interactions were not found. Among the overall sample, several predictors of T3 SI were identified: T1 depression [OR= 2.849, CI: 1.127, 7.561 , p= .029], T1 sexual harassment [OR= 1.124, CI: 1.024, 1.231 , p= .011], T2 depression [OR= 2.951, CI: .976, 8.125 , p= .042], T2 PTSD [OR= 5.033, CI: 0.983, 20.247 , p= .031], T2 comorbid PTSD and depression [OR= 6.699, CI: 2.614, 17.099 , p< .001], T2 comorbid depression and alcohol use disorder [OR= 9.207, CI: 1.723, 41.306, p= .005], remitted SI [OR= 10.848, CI: 3.254, 34.744, p< .001 ], new onset SI [OR= 40.609, CI: 11.846, 152.018, p< .001 ], and chronic SI [OR= 34.709, CI: 8.415, 153.7, p< .001 ]. Significant sex by predictor interactions did not occur for prediction of T3 SI.

Conclusions and Implications: The finding that males and females differed on initial status of several mental health and psychosocial factors builds the case that sex-specific interventions and services are needed for veterans. Among all veterans, having a psychiatric diagnosis of depression or PTSD, a comorbid psychiatric diagnosis, or a history of sexual harassment or SI increases the risk of downstream SI. New onset SI (SI at T2 but not T1), chronic SI (SI at T1 and T2), and remitted SI (SI at T1 but not T2) are extremely strong predictors of downstream SI. Therefore, prior SI as well as strong predictors such as comorbid PTSD and depression and comorbid depression and alcohol use disorder may be clinical indicators warranting more aggressive screening and intervention focused on suicide prevention.