Attempted suicide among Vietnam veterans: a model of etiology in a community sample

OBJECTIVE: Data from the National Vietnam Veterans Readjustment Study, conducted from 1986 to 1988, were used to develop an etiological model of attempted suicide among a community sample of 1,198 male Vietnam veterans. METHODS: In a three-step process, the authors used structural equation modeling to develop a model that they refined, cross- validated, and then specified in terms of its replicable paths. RESULTS: The final model possesses highly satisfactory fit and parsimony. General psychiatric disorders were the sole factors contributing directly to attempted suicide. General psychiatric disorders were in part products of both nonmilitary and military traumas, most specifically participation in abusive violence. Posttraumatic stress disorder (PTSD) and substance abuse were related to attempted suicide bivariately but not when considered in conjunction with general psychiatric disorders. Among premilitary risk factors, family instability contributed to attempted suicide indirectly through its influence on general psychiatric disorders. CONCLUSIONS: The etiology of attempted suicide among Vietnam veterans remains largely unexplained. A partial explanation is that the predominant and direct causes spring from general psychiatric disorders rather than from traumatic exposure, PTSD, or substance abuse. Traumatic exposure contributes directly to the development of PTSD and general psychiatric disorders but only indirectly to making a suicide attempt.