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Publication Briefs

Study Assesses Risk Factors for Suicide-Related Behavior among OEF/OIF Veterans with "Polytrauma Clinical Triad"

Suicide rates among both OEF/OIF service members and younger Veterans have been on the rise. PTSD and traumatic brain injury (TBI) are prevalent conditions among these Veterans, and studies also have identified high rates of chronic pain in this population. Affecting as many as 42% of Veterans receiving polytrauma care, the co-occurrence of PTSD, TBI, and chronic pain is known as the "Polytrauma Clinical Triad" (PCT). This retrospective cohort study examined the association of these conditions, independently and in interaction with other conditions, with the risk of suicide-related behavior (SRB) among OEF/OIF Veterans. Using VA data (inpatient and outpatient), investigators identified 211,652 Veterans who received VA healthcare in FY09-FY11. Measured outcomes included suicidal ideation, attempted suicide, and both ideation and suicide attempt in each of the three study years. Investigators also examined patient demographics and clinical characteristics, including conditions that are part of the PCT, as well as prior suicidal behavior, insomnia, and other mental health diagnoses (i.e., depression, anxiety, bipolar, substance abuse).


  • The Polytrauma Clinical Triad was a moderate predictor of suicide-related behavior, but did not appear to increase risk for SRB above that associated with PTSD, depression, or substance abuse alone. Moreover, PTSD comorbid with either depression or substance abuse significantly increased risk for suicidal ideation.
  • Veterans with a diagnosis of bipolar disorder, anxiety, substance abuse, schizophrenia, depression, or PTSD were significantly more likely to be diagnosed with all three categories of SRB.
  • Female Veterans were less likely than male Veterans to exhibit suicidal ideation, which contradicts prior research and may suggest that females are less comfortable reporting ideation within VA.
  • Of the 211,652 OEF/OIF Veterans in this study, 5,653 (3% of cohort) had suicide-related behavior: 4,310 (2%) had ideation only, 753 (0.4%) had attempt only, and 690 (0.3%) had both ideation and attempt. Risk for SRB was highest in the 18-25 year old age group.


  • VA administrative data do not report on completed suicides, therefore investigators could not determine which risk factors may be most closely related to risk of death by suicide.
  • Analyses were based on categorical rather than continuous variables, so do not address how suicide-related behavior may be affected by the severity of conditions (e.g., PTSD) or frequency of events (e.g., suicide-related behavior).


  • Results reassert the importance of depression and substance abuse as additional risk factors for suicide among OEF/OIF Veterans, particularly those with PTSD. Suicide prevention efforts may benefit from screening criteria tailored to address risk factors most salient for these Veterans.

This study was funded by HSR&D (DHI 09-237). Drs. Finley, Pugh, and Bollinger are part of the South Texas Veterans Health Care System.

PubMed Logo Finley E, Pugh M, Bollinger M, et al. A National Cohort Study of the Association between the Polytrauma Clinical Triad and Suicide-Related Behavior among US Veterans Who Served in Iraq and Afghanistan. American Journal of Public Health. July 17, 2014;e-pub ahead of print.

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