Posttraumatic Growth and Suicide in Veterans: Impact of Interpersonal Needs and Depression

Suicide rates are higher in veterans than civilians, perhaps due to increased trauma exposure (e.g., sexual trauma, combat). However, not all veterans who experience trauma are at increased risk for suicidal behavior as some may experience an increased sense of purpose and meaning in life via posttraumatic growth (PTG). PTG, conceptualized as a positive transformation following trauma that results in improved function, may involve changes in cognitive-emotional processing, including increased feelings of connectedness and perceptions of value and contribution contributing to the well-being of others, as well as beneficial shifts in mood. The interpersonal theory of suicide posits that individuals who feel isolated (thwarted belongingness; TB), or like a burden (perceived burdensomeness; PB) are at increased risk for depression and suicidal ideation and attempts. Veterans who experience PTG after trauma may experience a beneficial shift in perceptions related to interpersonal needs (e.g., feel more connected, feel like less of a burden), with consequent benefits to mood and suicide risk. This premise has not been previously examined; therefore, we assessed the serial mediating effects of thwarted interpersonal needs (i.e., TB and PB, in separate models) and depression on the link between PTG and suicidal behavior. Participants (N=545; 70.1% male (n=382); 86.4% Caucasian (n=469), Mean Age=49.86, SD=16.78) were community-dwelling veterans, who completed the Posttraumatic Growth Inventory, Interpersonal Needs Questionnaire, Multidimensional Health Profile, and Suicide Behaviors Questionnaire-Revised. Bivariate correlations and serial mediation analyses were conducted covarying age, sex, and ethnicity. Serial mediation analyses supported hypotheses (10,000 bootstrapped samples); the total indirect effect of PTG on suicidal behaviors was significant when thwarted belongingness (IE= -.024, SE= .005, CI= -.036 to -.015) and perceived burdensomeness (IE= -.024, SE= .006, CI= -.036 to -.014), along with depression, were examined as serial mediators. Specific indirect effects of PTG on suicidal behaviors were also significant through thwarted belongingness (IE= -.015, SE= .005, CI= -.026 to -.008) in the first model and perceived burdensomeness (IE= -.016, SE= -.005, CI= -.027 to -.008) in the second model; however, there were no specific indirect effects observed through depressive symptoms in either model. Our results suggest that the relation between PTG and reduced suicidal behavior may be due to serial, adaptive shifts in cognitive-emotional processing related to interpersonal functioning and mood which, in turn, beneficially impact mood and suicide risk. Of note, there were no significant specific indirect effects with depressive symptoms. This pattern elucidates a potential mechanism between PTG and suicidal behavior, highlighting that the process of PTG does not, initially, involve a reduction of depressive symptoms but, rather, an improvement in perceptions regarding social connectedness and social self-value that has a cascading effect on mental health functioning. Our findings may have clinical implications. Cognitive reframing of traumatic events (e.g., via Cognitive Processing Therapy) and bolstering relationships and the perception of one’s value in a social network (e.g., via Interpersonal Therapy) may reduce depression and suicide risk in veterans