Longitudinal associations between exposure to potentially morally injurious events and suicidal ideation among recently discharged veterans – The mediating roles of depression and loneliness

Background
Exposure to potentially morally injurious events (PMIEs) during military service is associated with heightened suicidal ideation (SI). However, no longitudinal study has established temporal associations between these variables and examined the possible mediating roles of depression and loneliness in this effect.

Methods
Participants were 374 active-duty Israeli combatants who participated in a five-year longitudinal study with four measurement points: T1- one year before enlistment, T2- one month before discharge from army service, and then again six months and twelve months following their discharge (T3 and T4, respectively). Data were assessed through semi-structured interviews and validated self-report questionnaires.

Results
Above and beyond pre-enlistment personal characteristics (T1) and combat exposure (T2), PMIEs-‘betrayal’ (T2) predicted more frequent SI over the past twelve months (T4) through the mediation of depression. Moreover, both PMIEs-‘betrayal’ and ‘self’ (T2) predicted more frequent SI over the past twelve months (T4) through the mediation of loneliness.

Limitations
We used self-report measures to assess PMIEs and SI, which may suffer from various biases.

Conclusions
Our findings are the first to provide evidence of longitudinal, temporal associations between exposure to PMIEs and SI. Notably, potential interventions might consider addressing the loneliness experienced following exposure to PMIEs during military service, among recently discharged traumatized veterans.

Highlights

•   This study examines longitudinal associations between PMIEs and SI among combat veterans.
•   PMIEs-‘betrayal’ predicted SI through the mediation of depression.
•   PMIEs-‘betrayal’ and ‘self’ predicted SI through the mediation of loneliness.