Am J Psychiatry 1995; 152:102-109
Copyright © 1995 by American Psychiatric Association
Attempted suicide among Vietnam veterans: a model of etiology in a community sample
A Fontana and R Rosenheck
VA Northeast Program Evaluation Center, West Haven, CT 06516.
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.
