Suicide research among veterans has focused on military-related factors, but preservice factors may be equally important (1). We examined whether adverse childhood experiences (ACEs), which are strongly associated with suicidal ideation (2), were associated with recent suicidal ideation among veterans.

On the 2012 Tennessee Behavioral Risk Factor Surveillance System, veterans (N=558) indicated whether they had considered taking their own life in the past 12 months and how many of up to nine ACEs they had experienced. We used multiple logistic regression to examine the independent association of ACEs with recent suicidal ideation, adjusting for sociodemographic variables; lifetime diagnoses of depression, anxiety, or posttraumatic stress disorder; receipt of psychological or psychiatric counseling or treatment in the past 12 months; lifetime traumatic brain injury (TBI) diagnosis; and combat service.

Prevalence of ACEs ranged from 10% for sexual abuse to 33% for household alcohol abuse; 20% experienced four or more ACEs. Approximately 8% of veterans indicated recent suicidal ideation. ACEs were significantly associated with recent suicidal ideation both before (odds ratio [OR]=1.41) and after adjustment for covariates (AOR=1.57) (Table 1). Serving in a combat zone and TBI were not significantly associated with recent suicidal ideation.

TABLE 1. Association of adverse childhood experiences (ACEs) with past-12-month suicidal ideation among U.S. veteransa Crude analysis (N=556) Adjusted analysis (N=540)b Variable OR 95% CI AOR 95% CI Adverse childhood experience 1.41 1.04–1.91 1.57* 1.09–2.27 Ever served in a combat zone — — .34 .10–1.21 Ever received diagnosis of traumatic brain injury — — .17 .03–1.00 Ever received diagnosis of depression, anxiety, or PTSD — — 9.26* 2.33–36.76 TABLE 1. Association of adverse childhood experiences (ACEs) with past-12-month suicidal ideation among U.S. veteransa Enlarge table

The association of ACEs with suicidal ideation, which supports a Canadian report (3), is remarkable for its significance after adjustment of relevant covariates and because it is chronologically more distal than military-related factors.

Suicide prevention efforts among current and former military personnel should include awareness of preservice trauma. Cumulative trauma histories may inform treatment decisions for select diagnoses or strategies for addressing suicide risk during periods of increased stress.

Dr. Blosnich is with the Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh. Dr. Bossarte is with the Injury Control Research Center and Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown. Send correspondence to Dr. Blosnich (e-mail: [email protected] ). Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column.