Health-promoting behaviors may buffer against suicide in veterans with PTSD

Everyday behaviors to improve health could be a key part of reducing suicide among veterans. New research suggests that health-promoting behaviors are important for reducing suicidal ideation among veterans with high levels of PTSD symptoms.

(If you are experiencing suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-8255 or follow this link to their online chat.)

The new study, published in the peer-reviewed journal PLOS One, was led by Bryann B. DeBeer of the Texas A&M Health Science Center and the U.S. Department of Veterans Affairs.

“Broadly, my research focuses on examining modifiable factors that predict suicide risk, and then translating these findings into novel suicide prevention efforts,” DeBeer told PsyPost. “My work is particularly focused on veteran and military populations affected by trauma exposure and posttraumatic stress disorder (PTSD). Health promoting behaviors interested me because they are habits that can be modified.”

“For example, we have existing programs within VA to address health promotion, such as the MOVE program (i.e., an exercise program) and nutritionists. However, these services are not traditionally linked with suicide prevention. Examining health promoting behaviors as a risk factor for suicidal ideation could provide useful information regarding how to leverage resources within the Veterans Health Administration.”

Health-promoting behaviors include a wide variety of activities. The researchers looked at behaviors that promoted nutrition, physical activity, stress management, spiritual growth, health responsibility (such as seeing a doctor), and interpersonal relationships.

The study examined 108 U.S. veterans of Operation Enduring Freedom and Operation Iraqi Freedom who were enrolled for health care at the Central Texas Veterans Health Care System.

“Veterans with PTSD are at high risk for suicidal ideation and behavior in comparison to veterans who are not diagnosed with PTSD. This is particularly important given that PTSD is the most common mental health diagnosis in VA and 20 veterans die each day from suicide,” DeBeer said.

Previous research has established that suicidal ideation – in other words, having suicidal thoughts — is one of the strongest predictors of suicide and suicide attempts.

DeBeer and her colleagues found that when engagement in health-promoting behaviors was high, PTSD had little impact on suicide ideation. In other words, veterans with severe PTSD who engaged in more frequent health-promoting behaviors had lower levels of suicidal ideation compared to veterans with severe PTSD who engaged in these behaviors less frequently.

“In fact, those individuals with high PTSD symptoms who engaged in health promoting behaviors had similar levels of suicidal ideation as individuals with low PTSD symptoms,” he explained. “In sum, health promoting behaviors may buffer against suicide risk in individuals experiencing high PTSD symptoms.”

Though the findings look promising, they are still preliminary.

“The study used a cross-section design, which is useful because it shows risk and protective factors at one point in time,” DeBeer told PsyPost. “However, we don’t know whether health promoting behaviors predict future suicidal ideation, which is important for long-term suicide prevention. Thus, future research should replicate these findings within the context of a longitudinal study design in order to determine if the results remain significant over time.”

“All participants were post-9/11 veterans who were enrolled in VA health care. It is unclear how these findings translate to veterans from other war theatres and those who do not seek VA health care.”

“In terms of future questions to be addressed, more research is needed to determine whether leveraging existing VA resources such as the MOVE program and nutritional services when a veteran enters treatment for PTSD has a significant impact on suicidal ideation and behavior.”

DeBeer added that suicide prevention efforts should be better integrated into the health care system as a whole.

“Often the primary focus of suicide prevention falls to mental health providers. However, I believe that suicide prevention should be present in all aspects of healthcare, not just mental health,” he told PsyPost. “There should be a no-wrong-door approach to helping veterans and making sure that we are addressing suicide prevention from a holistic approach.”

The study, “Predicting Suicide Risk in Trauma Exposed Veterans: The Role of Health Promoting Behaviors“, was also co-authored by Julie A. Kittel, Andrew Cook, Dena Davidson, Nathan A. Kimbrel, Eric C. Meyer, Suzy B. Gulliver, and Sandra B. Morissette. It was published December 21, 2016.