Characterizing aggression and suicide attempts among high-risk U.S. Veterans: Demographic, clinical, and military...

Suicide prevention is a top priority of the Department of Veterans Affairs (VA), and improving the effectiveness of prevention efforts requires more precise identification of those at risk for suicide. Recent research identifies aggression as a risk factor for veteran suicide, yet little is known about moderators of the aggression-suicide association. This study examines demographic, clinical, and military characteristics as potential moderators of the association between aggression and suicide in a sample of veterans at high risk for suicide. This cross-sectional study used baseline data from a randomized clinical trial across four VA sites. Participants (n = 207veterans; 82.13% men) completed a clinical interview of suicide attempts and clinical characteristics and self-report measures of aggression, demographics, and military characteristics. We fit zero-inflated negative binomial models with interaction terms between aggression and each characteristic to test for moderators of the aggression-suicide association. None of the veteran characteristics had a significant main effect on number of suicide attempts. Across all four aggression subscales, gender and deployment history moderated the aggression-suicide association such that veteran women and those without a history of deployment had stronger positive associations between aggression and suicide. The present study adds nuance to our understanding of the relationship between aggression and suicide in veterans. Findings suggest that intervention efforts for high-risk veterans should focus on the role of aggression for veteran women and those without a history of deployment. Further research is warranted to validate findings and develop more precise suicide prevention efforts.