Staff Perspective: Article Review - Combined PTSD and Depressive Symptoms Interact with Post Deployment Social Support to Predict Suicidal Ideation in OEF and OIF Veterans

Staff Perspective: Article Review - Combined PTSD and Depressive Symptoms Interact with Post Deployment Social Support to Predict Suicidal Ideation in OEF and OIF Veterans

DeBeer, B., B., Kimbrel, N. A., Meyer, E. C., Gulliver, Suzy B., Morisette, S. B.  Combined PTSD and Depressive Symptoms Interact with Post-Deployment Social Support to Predict Suicidal Ideation in Operation Enduring Freedom and Operation Iraqi Freedom Veterans,  Psychiatry Research,

In recent years, with the rising rate of suicide among Service members (SM) and Veterans, much attention has been given to factors that contribute to suicide in this population.  The authors note that many returning SM experience psychological problems that are known to be associated with higher suicide risk.  For example, they cite research pointing to elevated suicide risk among SM who experience symptoms of PTSD, MDD, TBI, alcohol use, and psychosis, just to name a few.  They point out that MDD and PTSD often co-occur and have overlapping symptoms such as withdrawal and negative mood states.  In fact, these authors suggest that a single dimension reflecting both PTSD symptoms and MDD symptoms may best represent the experience of some returning Veterans and may contribute to suicide risk to more or less of a degree, depending on level of perceived social support.  The aim of this article is to inform prevention and treatment efforts by examining the influence of social support on the relationship between a PTSD-depression factor and suicidal ideation.   The authors predicted that the effect of the PTSD-depression factor on suicidal ideation would be stronger among those with low social support and higher among those with high social support. 

The study included 130 OEF/OIF Veterans from the Central Texas Veterans Health Care System.  Measures used included: the Mini International Neurospsychiatric Interview (MINI), the Clinician-Administered PTSD scale (CAPS), the PTSD Checklist, Military Version (PCL), the Anxiety Disorders Interview-IV (ADIS-IV), the Beck Depression Inventory-II (BDI-II), the Beck Scale for Suicidal Ideation (BSS), and the post-deployment social support scale (PDSS). 

Overall, findings support the authors’ hypothesis that social support interacts with a PTSD/depression factor to reduce suicidal risk.  Those who report higher PTSD/depression factor scores along with perceived lower social support may be at higher risk for suicidal ideation than those individuals who report either risk factor alone. 

Other pertinent findings include the high rates of PTSD (42%) and MDD (30%) as well as the high rate of suicidal ideation (18.5%) among the sample.  Also of note was the high rate of comorbidity between those with PTSD and MDD, a finding from prior research as well.   

The authors point out that the findings from their study have implications for assessing risk and improving treatment planning.  In terms of assessing risk, clinicians can remain confident that individuals with low social support and perceived low social support are likely at higher risk of having suicidal ideation (and presumably at higher risk of suicide).  They also point out that an evaluation of accuracy about social support may be a helpful part of intervention.  In addition, it follows that treatment that focuses on increasing the quality and/or quantity of social support may be an important part of working with SM and Veterans with depression and/or PTSD symptoms.

As for future directions, the authors suggest that it would be helpful to study whether social support prospectively predicts suicide risk and if change in social support is a sensitive measure of suicide risk.  Also helpful would be studies which examine the most effective treatments for improving social support and the impact of different types and aspects of social support. 

In summary, this study has made an advancement in the area of suicide risk assessment and treatment of suicidal SM, particularly among SM with symptoms of PTSD and depression. The authors have provided support for a combined PTSD-MDD factor and shown that this factor influences suicidal risk differently for varying levels of perceived social support.  Given that social support has been a variable of interest for years in the suicide literature, it is beneficial to have the clarification on this provided by this study.

Dr. Regina Shillinglaw is a deployment behavioral health psychologist with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.  Located at Wright Patterson Medical Center in Ohio, she is a faculty member and the assistant training director in the APA-approved pre-doctoral psychology internship training program.