Combat Exposure and Risk for Suicidal Thoughts and Behaviors Among Military Personnel and Veterans: A Systematic Review

Traumatic Brain Injury. ● Relationship provisions, self-efficacy and youth well-being in military families. ● Relationship provisions, self-efficacy and youth well-being in military families. ● Longitudinal determinants of mental health treatment-seeking by US soldiers. and depressive symptoms. ● Meta-analysis of risk factors for secondary traumatic stress in therapeutic work with trauma victims. ● Prevalence and correlates of co-prescribing psychotropic medications with long-term opioid use nationally in the Veterans Health Administration. ● Risk and resilience factors associated with posttraumatic stress in ethno-racially diverse National Guard members in Hawai‫׳‬i. ● Imagery vividness ratings during exposure treatment for posttraumatic stress disorder as a predictor of treatment outcome. Due to seemingly mixed empirical results, questions persist about the possible role of deployments and combat exposure. We conducted a narrative review and meta-analysis of 22 published studies to integrate findings regarding the relationship of deployment-related predictors (i.e., deployment, deployment to a combat zone, combat experience, and exposure to specific combat events) with suicide-related outcomes (i.e., suicide ideation, attempt, and death). Across all predictors and outcomes, the combined effect was small and positive, r = .08 [0.04, 0.13], and marked by significant heterogeneity, I2 = 99.9%, Q(21)=4880.16, p < .0001, corresponding to a 25% increased risk for suicide-related outcomes among those who have deployed. Studies examining the relationship between exposure to killing and atrocities (k = 5) showed the largest combined effect, r = .12 [0.08, 0.17], and less heterogeneity, I2 = 84.4%, Q(4)=34.96, p < .0001, corresponding to a 43% increased risk for suicide-related outcomes among those exposed to killing or atrocity. Implications for theory, research, and clinical practice are discussed. Background Individuals vetted by the government for initial or continuing eligibility to access classified information must fill out a personnel security questionnaire as part of a screening process designed to identify those who are not likely to be trustworthy, reliable , or loyal to the United States. Question 21 in the Questionnaire for National Security Positions (SF-86) asks applicants if they have consulted with a mental health professional in the last 7 years , with certain groups exempted. This approach identifies too many individuals for investigative follow-up who do not have a mental health condition that pose s an unacceptable risk , and likely misses other at-risk individuals. Disagreements over the goal, effectiveness , and adverse consequences (e.g., stigmatizing the use of mental health services) associated with this question have resulted in previous Question 21 …