Veterans' Loneliness: A Path to Suicidality

Featured Article | Traumatology | 2024, p. 1-7 

Loneliness in Veterans: A Commonality Across Multiple Pathways Toward Suicidality

Katherine Musacchio Schafer - Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, Tennessee, United States, and Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Emma Wilson-Lemoine - Department of Psychology, Kings College London, London, United Kingdom, and Department of Psychology, Florida State University

Thomas Joiner - Department of Psychology, Florida State University

Veterans are significantly more likely to experience suicidality than the general population. A substantial amount of research has centered on risk factors of suicidality among veterans, identifying associations between Military-relevant risk factors including traumatic brain injuries (TBIs) and combat exposure with suicidality. Likewise, loneliness has been shown to be a strong correlate of suicidality. Among these constructs, loneliness is proposed by multiple recent theories of suicide to contribute to the development of suicidality. Thus, in the present study, we investigate the link between these three variables (i.e., TBI, combat exposure, and loneliness) with suicidality. We then investigate the mediating role of loneliness between TBI and combat exposure with suicidality. Using cross-sectional data from 1,469 veterans recruited in the Military Health and Well-Being Project, we conducted linear regression analyses and mediational models. Findings indicated that loneliness (β = .32) was most closely associated with the outcome variable (suicidality) compared to combat exposure (β = .11) and TBI (β = .12). Further, loneliness partially mediated the link between all other variables with suicidality at p , .001. These findings underscore the importance of loneliness in the experience of suicidality among veterans and indicate that cross-sectional effects between military-relevant risk factors including TBI and combat exposure with suicidality are driven through loneliness. Within the relationships between TBI and suicidality as well as combat exposure and suicidality, loneliness plays an integral role, channeling the effects of the independent variables.

loneliness, traumatic brain injury, combat exposure, suicidality, veterans

Suicide has been increasing at alarming rates in the United States, especially among veterans, despite increased efforts to address the issue. Veterans face a higher risk of suicidality compared to civilians, with factors like combat exposure and traumatic brain injuries contributing to this elevated risk. Likewise, loneliness has emerged as a crucial factor in veterans' mental health and suicidality. 

Examining the heightened risk of suicidality among veterans, this study delves into the interplay between traumatic brain injuries (TBIs), combat exposure, and loneliness. Prior research has consistently identified loneliness as a significant risk factor for suicide, both within the general population and specifically among veterans. Within the veteran population, TBI and combat exposure have both been associated with a twofold increase in suicidality. Given the elevated risk of suicidality among veterans, the study aims to examine the association between these three factors, the contributions of each factor, and loneliness as a mediator between both variables and suicidality.  

The study utilized data from the Military Health and Well-Being Project. A total of 1,469 U.S. military veterans completed the survey, meeting inclusion criteria and providing data for analysis. Measures included self-reported history of traumatic brain injury (TBI), the Combat Exposure Scale (CES), the UCLA Loneliness Scale, and the Suicidal Behavior Questionnaire-Revised (SBQ-R). 

Findings revealed that loneliness was more strongly associated with and had a greater relative contribution to suicide compared to TBIs and combat exposure. Moreover, loneliness partially mediated the relationship between TBIs and combat exposure to suicidality. These results suggest that the relationship between TBI, combat exposure, and suicidality is partially influenced by loneliness, emphasizing the role of loneliness as a contributing factor in veterans' experiences of suicidality.

The study aligns with previous research highlighting the significance of loneliness in veterans' experiences of suicidality and its interplay with other risk factors. The findings suggest that addressing loneliness may hold promise as a key strategy in mitigating the risk of suicidality among veterans. 

Promoting Social Connectedness in Treatment: Therapeutic interventions should prioritize teaching and fostering social connections among veterans to combat suicidality. This approach aligns with existing research emphasizing the importance of social integration and skills in reducing suicide risk. Various techniques can be utilized to promote social connectedness, such as group therapy sessions, peer support programs, and community engagement initiatives.

Targeting Loneliness in Therapy: Rather than solely focusing on veteran-specific risk factors, therapists should prioritize addressing loneliness, which underlies the relationship between military-related constructs and suicidality. Targeting loneliness may offer a more effective and precise therapeutic approach.

Screening for Loneliness in Healthcare: Clinicians and healthcare providers should implement routine screening for loneliness and social isolation among both incoming and existing veteran patients. Early identification of loneliness can facilitate timely intervention and support.

“This study boasts many strengths including a large diverse sample measured across a variety of variables of interest. However, findings should be interpreted in light of some limitations. First, these data are cross-sectional, thus the temporal antecedence and causal mechanisms could not be inferred or tested. Additionally, these data are self-report, meaning that respondents may have either exaggerated or minimized their symptoms or may have misunderstood the prompts entirely. Further, the outcome variable combines many suicide-related outcomes (e.g., suicidal ideation, suicide intent, suicide attempts, etc.) into a single category. This is problematic in that theories propose causal mechanisms toward specific suicide-related outcomes (e.g., suicidal ideation, suicide attempts, and suicide death). Thus, combining these constructs into a single outcome measure renders it impossible to directly test the mechanisms that theories put forth. Finally, the constructs in the present project are likely strongly related to PTSD. While it is of interest to study these constructs in the context of PTSD, this could not be explicitly investigated, as PTSD was not explicitly measured in the military health and well-being project. We recommend that future work investigate military-relevant risk factors and their relation to suicidality while accounting for the development of PTSD” (p. 5-6).

• Veteran Identity and Mental Health: Initiation into the Military - Part 1
• Veteran Identity and Mental Health: Military Service - Part 2
•  Veteran Identity and Mental Health: Military Service and Trauma - Part 3 
• Veteran Identity and Mental Health: Post-Military Life - Part 4