Beyond trauma: The influence of spiritual struggles on suicide risk in post-9/11 veterans

Veterans with posttraumatic stress disorder (PTSD) and moral injury often struggle with their spirituality and/or religion (S/R) in ways that hinder recovery from these conditions and perpetuate risk for suicide over time. Focusing on veterans who were engaged in a peer-led spiritual intervention program with a Veteran Service Organization, this brief report examined prospective roles of common forms of spiritual struggles (divine, doubt, interpersonal, moral, meaning) in risk for suicidal behavior (ideation, attempt probability) over a 1-year period.

Participants completed self-report assessments of PTSD symptoms, moral injury outcomes, spiritual struggles, and suicidality at three points (baseline and 6-month and 12-month follow-ups).

Initial analyses revealed baseline levels of all spiritual struggles were weakly to moderately concurrently associated (rs = .215-.491) with suicidality factors at this baseline assessment. However, ultimate meaning struggles at baseline emerged as the only salient predictor of future suicide ideation and perceived likelihood of attempting suicide across the bivariate and multivariate analyses. Specifically, veterans who were concerned their lives or existence in general may not have a deeper purpose or underlying meaning at the start of the intervention program were more uniquely likely to be thinking about suicide and perceiving a greater likelihood of attempting suicide in the future over the 1-year period.

Overall, these findings affirm the need for clinicians and researchers to attend to ultimate meaning struggles in their work with veterans and other trauma-exposed groups who might be at risk for suicide. (PsycInfo Database Record (c) 2026 APA, all rights reserved).