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. 2014 Dec 15;220(1-2):397-403.
doi: 10.1016/j.psychres.2014.07.064. Epub 2014 Aug 14.

The factor structure of psychiatric comorbidity among Iraq/Afghanistan-era veterans and its relationship to violence, incarceration, suicide attempts, and suicidality

Nathan A Kimbrel  1 , Patrick S Calhoun  2 , Eric B Elbogen  3 , Mira Brancu  4 ; VA Mid-Atlantic MIRECC Registry Workgroup  5 ; Jean C Beckham  4
Collaborators, Affiliations

The factor structure of psychiatric comorbidity among Iraq/Afghanistan-era veterans and its relationship to violence, incarceration, suicide attempts, and suicidality

Nathan A Kimbrel et al. Psychiatry Res. .

Abstract

The present research examined how incarceration, suicide attempts, suicidality, and difficulty controlling violence relate to the underlying factor structure of psychiatric comorbidity among a large sample of Iraq/Afghanistan-era veterans (N=1897). Diagnostic interviews established psychiatric diagnoses; self-report measures assessed history of incarceration, difficulty controlling violence, suicide attempts, and suicidality. A 3-factor measurement model characterized by latent factors for externalizing-substance-use disorders (SUD), distress, and fear provided excellent fit to the data. Alcohol-use disorder, drug-use disorder, and nicotine dependence were indicators on the externalizing-SUD factor. Posttraumatic stress disorder and depression were indicators on the distress factor. Panic disorder, social phobia, specific phobia, and obsessive-compulsive disorder were indicators on the fear factor. Incarceration was exclusively predicted by the externalizing-SUD factor. Difficulty controlling violence, suicidality, and suicide attempts were exclusively predicted by the distress factor. Contrary to hypotheses, the path from the externalizing/SUD factor to difficulty controlling violence was not significant. Taken together, these findings suggest that the distress factor of psychiatric comorbidity is a significant risk factor for suicidality, suicide attempts, and difficulty controlling violence and could help to explain the frequent co-occurrence of these critical outcomes among returning Iraq/Afghanistan veterans.

Keywords: Anxiety; Depression; PTSD; Substance abuse; Suicide; Violence.

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Figures

Figure 1
Figure 1. Hypothesized Measurement Models in Samples 1 and 2
All parameters shown are fully standardized. *p < .05; **p < .01; ***p < .001.Overall model fit was excellent in both sample 1, χ2 (19) = 22.049, p = .28, RMSEA = .01, CFI = .99, TLI = .99, WRMR = .73, and sample 2, χ2 (19) = 24.491, p = .18, RMSEA = .02, CFI = .99, TLI = .98, WRMR = .77.
Figure 2
Figure 2. Hypothesized Structural Model in Samples 1 and 2
All parameters shown are fully standardized. *p < .05; **p < .01; ***p < .001.Overall model fit was excellent in both sample 1, χ2 (37) = 43.181 p = .22, RMSEA = .01, CFI = .99, TLI = .99, WRMR = .76, and sample 2, χ2 (38) = 24.491, p = .06, RMSEA = .02, CFI = .98, TLI = .98, WRMR = .84.
Figure 3
Figure 3. Final Alternative Structural Model in Samples 1 and 2
All parameters shown are fully standardized. *p < .05; **p < .01; ***p < .001.Overall model fit was excellent in both sample 1, χ2 (38) = p = .26, RMSEA = .01, CFI = .99, TLI = .99, WRMR = .76, and sample 2, χ2 (39) = 52.5101, p = .07, RMSEA = .02, CFI = .98, TLI = .98, WRMR = .84.
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