(PS9-D84) Examining the Relationship Between PTSD and Suicidality Through the 3-step Theory of Suicide in a Population of Women Veterans Who Have Experienced Military Sexual Trauma (MST)

Background: U.S. military veterans are at a greater risk of suicide than non-veteran adults, and this risk is exacerbated in women veterans who have post-traumatic stress disorder (PTSD) related to military sexual trauma (MST). The Three-Step Theory (3ST) by Dr. David Klonsky is an evidence-based model for the development of suicidal ideation (SI) into suicidal action, which suggests that hopelessness paired with physical or psychological pain exacerbates suicidal thoughts, while lack of connection may lead to a suicide attempt. The theory suggests that lower interpersonal problems should reduce the severity of suicidal thinking. However, very few studies have examined the role of hopelessness and interpersonal problems on the association between PTSD and SI informed by the 3ST in women veterans with MST. This secondary analysis aims to fill this gap.

Method: The sample consists of 220 women military veterans with military sexual trauma (MST) who completed baseline assessments for a randomized clinical trial comparing a skills training in affective and interpersonal regulation (STAIR) to present-centered therapy (PCT). While only a positive screen for PTSD was an inclusion criterion, 90% of the sample (n=198) met criteria for PTSD on the PCL-5 (≥ 31). Participants are assessed for PTSD (PCL-5), suicidality (BDI item 9), hopelessness (BDI item 2), and perceived interpersonal problems (IIP). Moderation models were run using the PROCESS for SPSS.

Results: The three-way interaction between PTSD, hopelessness, and interpersonal problems was non-significant (b = − 0.0002, p = .32). We next examined two-way interactions and found an interaction between hopelessness and interpersonal problems (b = 0.007, p = .004). At high hopelessness, there was a significant positive relation between interpersonal problems and suicidal thoughts (b = 0.006, p = .02) and, at low hopelessness, there was a significant negative relation (b = - 0.008, p = .05). There was also a trending two-way interaction between hopelessness and PTSD (b = 0.006, p = .07). At high hopelessness, there was a significant positive interaction between PTSD and suicidal thoughts (b = 0.01, p = .003), and at low hopelessness PTSD was not significantly related to suicidal ideation (b = 0.007, p = .86).

Discussion: Partially in line with the 3ST, we found that higher psychological pain (PTSD) coupled with higher hopelessness led to higher suicidal thoughts while PTSD with lower hopelessness did not. However, we did not find that lower interpersonal problems buffered this interaction. Rather, we found that higher interpersonal problems coupled with hopelessness is related to higher suicidal thoughts. In summary, in women veterans with MST, having interpersonal problems and lack of connection may lead to exacerbated suicidality at high levels of hopelessness, suggesting that improving social relationships may be even more vital in this population.