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Publication Briefs

PTSD-Multimorbidity in Recently Discharged Veterans Predicts Poor Social Functioning, Increasing Risk for Suicidal Ideation

A growing body of literature suggests that problems experienced by Veterans during their transition from military to civilian life confer significant risk for suicidal ideation (SI). One of these problems is PTSD, which, along with chronic pain and sleep disturbance, can increase risk for SI. Using longitudinal data on the self-reported disorders of 5,461 trauma-exposed Veterans from The Veterans Metrics Initiative Study, investigators assessed: 1) the extent to which PTSD co-occurs with sleep disturbance and chronic pain (PTSD-multimorbidity); 2) the impact of PTSD-multimorbidity on later social functioning and SI; and 3) the extent to which social functioning mediates the impact of PTSD-multimorbidity on SI.


  • At approximately 15 months post-separation, almost 91% of Veterans with probable PTSD also reported sleep disturbance and/or chronic pain. Relative to Veterans with PTSD alone, sleep disturbance and chronic pain did not confer greater risk for SI.
  • Relative to Veterans without probable PTSD, Veterans with all three conditions (n = 907) experienced the poorest social functioning and had greater risk for suicidal ideation.
  • The impact of PTSD-multimorbidity on risk for SI was partially explained by its negative effect on social functioning.


  • Clinicians treating post-9/11 Veterans with PTSD should also assess co-occurring chronic pain and sleep disturbance and their impact on functioning.
  • Given the additional risk for suicidal ideation associated with poor social functioning, clinicians should be mindful to not only support Veterans' efforts to seek social support, but also to monitor the quality of support received and integrate social functioning aims into treatment planning.


  • The main limitation of this study was the use of single-item, self-report measures of chronic pain, sleep disturbance, and suicidal ideation – and the fact that PTSD could not be confirmed without a clinician-administered assessment.

This study was partly funded by HSR&D. Drs. Shor, Borowski, Zelkowitz, Pineles, and Vogt are part of the National Center for PTSD at VA Boston Healthcare System. Dr. Vogt is also part of HSR&D’s Center for Healthcare Organization & Implementation Research (CHOIR) in Bedford and Boston, MA.

Shor R, Borowski S, Zelkowitz R, Pineles S, Copeland L, Finley E, Perkins D, and Vogt D. The Transition to Civilian Life: Impact of Comorbid PTSD, Chronic Pain, and Sleep Disturbance on Veterans’ Social Functioning and Suicidal Ideation. Psychological Trauma: Theory, Research, Practice, and Policy. June 2, 2022; online ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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