Perceived betrayal moderates the effects of battlefield experiences on suicidal ideation and help-seeking

Suicide is one of the leading causes of death among military personnel, and help-seeking is crucial to combating it. Research has not yet investigated the role that potentially morally injurious events (PMIEs), particularly betrayal, may play in moderating the effect of battlefield experiences on these variables. Data from 694 U.S. Army personnel, all of whom had at least one combat deployment, were analyzed to examine battlefield life-threatening experiences (LTEs), suicidal ideation, help-seeking behavior, PMIEs, depressive symptoms, anxiety symptoms, posttraumatic stress disorder (PTSD) symptoms, and aggression. Analyses revealed a significant interaction between LTEs and betrayal-type PMIEs predicting both a higher likelihood of suicidal thoughts and planning, relative risk ratio = 1.729, z = 2.13, p = .034, 95% confidence interval (CI) [1.043, 2.863], and help-seeking from fewer sources, incident rate ratio = 0.927, z = -2.26, p = .024, 95% CI = [0.868, 0.990]. These effects held even when controlling for depressive symptoms, anxiety symptoms, PTSD symptoms, and aggression. The findings suggest that betrayal-type PMIEs have a significant moderating effect on the impact of LTEs on suicidal ideation and help-seeking behavior, and this effect cannot be explained by the experience of the other four measured symptoms of psychological distress.