Commentary: Adverse Childhood Experiences and Risk for Suicidal Behavior in Male Iraq and Afghanistan Veterans Seeking PTSD Treatment

The authors of a recently published article entitled, " Adverse childhood experiences and risk for suicidal behavior in male Iraq and Afghanistan veterans seeking PTSD treatment " by Carroll et al. (1) examined a range of adverse childhood experiences (ACEs) among Iraq/Afghanistan veterans with combat-related posttraumatic stress disorder (PTSD). The researchers found that the majority of veterans had experienced multiple types of adversities during childhood and/or adolescence. More than 80% of veterans reported experiencing at least one childhood trauma or adversity. About 40% of study participants endorsed four or more childhood traumas or adversities. Veterans who reported physical neglect as a child were significantly more likely to report a history of attempting suicide. It is important to note that studies of civilian populations suggest that ACEs are very strong correlates of adulthood suicide risk (2–4). Research on psychiatric disorders and suicide risk among active duty personnel and military veterans tends to focus on traumas related to the military service (5–7). However, a focus on service-related traumas does not provide a complete picture. The observations by Carroll et al. (1) are consistent with reports that pre-military experiences such as adversity in childhood play an important role in post-deployment mental health (7–9). For example, Van Voorhees et al. (9) studied about 1,300 veterans and active duty soldiers to examine the link of childhood abuse with adult PTSD after taking into account combat experience. Forty percent of the sample reported at least one childhood traumatic event. The authors observed that ACE and adult combat experience independently influenced PTSD symptomatology. The results of studies by Blosnich et al. (10) and Afifi et al. (11) indicate that the military service may be a way for some people to replace dysfunctional home environments with more structured and directive environments. It is worth noting that there may be other reasons why people with a history of ACE may seek a military environment later in life. Blosnich et al. (10) compared the prevalence of childhood adversities among persons with and without a history of military service in the United States. They used the ACE inventory to assess 11 negative experiences before the age of 18 years. In the all-volunteer era (since 1973), men with a history of military service had a higher prevalence of ACEs in all 11 categories than men who did not serve in the military. A similar observation was made by