Moral injury, suicide ideation, and behavior among combat veterans: The mediating roles of entrapment and depression

Abstract

Combat veterans have been identified as a major at-risk group for suicide. Moral injury (MI) experiences have recently been acknowledged as significant stressful combat events that may lead to psychopathology, such as suicidal ideation and behaviors (SIB). In this study, we aimed to examine to what extent potential MI events may comprise risk factors for SIB and to explore the mediating role of the entrapment experience in this relationship. A sample of 191 Israeli combat veterans (Mage = 25.39, SD = 2.37) completed validated self-report questionnaires in a cross-sectional design study. All potential MI experiences were significantly related to SIB levels among veterans. Moreover, self- and betrayal-based MI experiences were significantly associated with sense of entrapment, which subsequently was associated with high levels of SIB. The integrative model indicated that entrapment and depression served as mediators in the association of MI-SIB. Even years after their release from military service, veterans exposed to potential MI experiences may still feel consumed by their painful memories and still have premonitions of a foreshortened future. Thus, they are more prone to SIB as well as to other mental health problems.