Suicide Cognitions Among Veterans: A Construct for Assessment and Intervention

Military veterans represent a population that is more likely to be exposed to traumatic events and therefore diagnosed with posttraumatic stress disorder (PTSD) compared to civilian men and women. Military sexual trauma (MST) is a traumatic event endorsed by approximately 28% of women veterans and 1.5% of male veterans. Not only are survivors of MST more likely to be diagnosed with PTSD than survivors of other traumas, they are also at risk for significant psychosocial consequences and comorbid psychiatric diagnoses. Of particular significance, veterans with MST-related PTSD report increased suicidal ideation and report higher incidences of suicidal self-directed violence (SDV). The Veterans Health Administration (VHA) has placed emphasis on both screening for MST and suicide prevention efforts. As a result, providers within the VHA have a greater opportunity to provide clinical care to a vulnerable population. However, research is mixed regarding whether veteran survivors of MST are more or less likely to utilize health care services within the VHA. Women veterans who have experienced MST in particular have been found to be less likely to utilize VHA health care services. This dissertation sought to increase understanding of suicide cognitions as a construct for assessment as well as potential treatment-seeking barriers and consists of two studies, each a secondary analysis of an RCT examining the efficacy of CPT in treating MST-related PTSD. The aim of the first study was to evaluate the psychometric properties of the SCS and identify the optimal factor structure. A four-factor structure was identified and the SCS was psychometrically valid in this sample. The purpose of the second study was to investigate whether suicide cognitions predict greater or lesser medical and mental health care utilization among female veterans with MST-related PTSD. Both logistic regression analyses and hierarchical multiple linear regression analyses were conducted to identify whether SCs predict medical (inpatient and outpatient) and mental health (inpatient and outpatient) care utilization. Decreased physical health concerns and unbearability predicted inpatient medical care utilization. These studies provide additional support for how SCs can be utilized to improve assessment of suicide risk, as well as inform clinical approaches.