Associations of self-directed violence among traumatic stress correlates: Network analysis and comparison in veteran men and women

Suicidal self-directed violence (SDV) is elevated among those exposed to trauma, making it critical to understand how features of traumatic stress relate to SDV outcomes. We used network analysis to identify the associations of three SDV outcomes (recent suicidal ideation, recent suicide planning, lifetime suicide attempt) with other correlates of traumatic stress in two samples of U.S. veterans. Sample 1 included veterans from any service era (N = 911, 53.0 % women), and Sample 2 encompassed veterans from the post-9/11 era who had recently separated from service (N = 1089, 57.0 % women). Participants self-reported current posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, and risky/self-destructive behaviors (i.e., nonsuicidal self-injury, binge drinking, drug use, binge eating, purging, excessive exercise, and fasting). We estimated networks using mixed graphical models and identified edges connecting correlates to SDV outcomes in each sample. The PTSD symptom cluster of negative alterations in cognitions and mood, depressive symptoms and nonsuicidal self-injury consistently emerged as correlates of SDV outcomes. We used the network comparison test to compare network strength, structure, and SDV connections across samples and between veteran men and women. We found no evidence to support differences in network strength or structure across samples. The network structure differed significantly for men compared to women (M = 0.193, p = .017), but network strength did not differ between these groups. Similarly, connections to SDV outcomes did not differ between veteran men and women. Findings suggest the importance of targeting specific correlates of traumatic stress to ameliorate SDV risk.