(PS2-C70) How Is Post-deployment Meaning in Life Associated with Stressors and Suicidal Ideation? A Mediation Analysis in a Longitudinal Veteran Cohort

Background. Deployed military personnel have a high likelihood of exposure to traumatic events including emergency or crisis situations and may experience further stressors and traumatic events upon return home.¹ While exposure to stressors is associated with risk for suicidal ideation (SI), meaning in life (i.e., purpose, beliefs, goals, and subjective feelings) can be a protective factor. Less is known about how meaning in life may affect the relationship between stressors and SI and how this may interact with protective effects of social support.  This investigation in formerly deployed US Veterans examined whether meaning in life mediates the relationship between stressors and suicide ideation in a longitudinal cohort.

Methods. The Survey of the Experiences of Returning Veterans cohort study is a longitudinal and national survey of  Veterans recently returned from deployment in Iraq, Afghanistan, and surrounding regions. Veterans were recruited using internet, media outlets, and the Department of Veterans Affairs, which offered a more representative sample of all Veterans than studies including only Veterans engaged in treatment at the VA. Additionally, women were oversampled to facilitate gender comparison. This analysis included 442 participants who responded to suicide questions at months 0, 3, 6, 9, and 12. Suicidal ideation (Columbia-Suicide Severity Rating Scale)², stressors (Deployment risk and resilience inventory-2, DRRI)³, meaning in life (Presence of Meaning in Life),⁴ and social support (DRRI)³ were assessed at each time point. Models assessed whether meaning in life at the previous timepoint mediated the association between DRRI stressors at the previous timepoint and suicidal ideation at the current timepoint, and included covariates for visit time, age, sex, race, ethnicity, income, and time since separation. Suicidal ideation, DRRI stressors, social support, and meaning in life were all treated as continuous variables in our models.

Results. The proportion of stressors effect mediated by meaning in life was 14.1% (7.3%-25.4%; p = 0.0013), after adjusting for visit time, age, sex, race, ethnicity, income, time since separation, and social support. The adjusted proportion of stressors effect mediated by meaning of life and social support was 33.6% (21.8%-47.8%; p = < .0001).

Discussion. This longitudinal cohort study among a population with high likelihood of past and current exposure to crises found that meaning in life appears to exert a protective effect against suicidal ideation, especially when paired with social support. Strengths of this study include a longitudinal sample and use of validated measures. Findings suggest that incorporating meaning in life into clinical interventions, as is done in Dialectical Behavior Therapy,⁵ for example, and building social support, may help mitigate risk for suicidal ideation among Veterans exposed to crises and stressors.