A Commotion in the Mind: Direct and Indirect Associations of Moral Injury Symptom Severity and Stoicism with Suicide Risk in U.S. Military Veterans

Abstract

Moral injury (MI) and stoicism have mixed independent associations with suicide risk among U.S. military veterans, yet little is known about how these constructs interact. We examined direct and indirect associations among MI symptom severity, stoicism, and suicide risk. Study participants were U.S. military veterans (N = 3,188) who completed a cross-sectional survey. The sample was randomly partitioned into calibration and validation subsamples; measurement models were calibrated in the former and tested in the latter, where the primary structural equation model estimated direct and indirect associations among MI symptom severity, stoicism, and suicide risk, accounting for demographic covariates. Stoicism was measured using the Brief Stoicism Scale (BSS), a newly developed instrument validated in this study. The primary structural model fit the data well (CFI = .95, TLI = .94, RMSEA = .05). MI symptom severity was positively associated with suicide risk (β = 0.27) and negatively with stoicism (β = −0.42); stoicism was negatively associated with suicide risk (β = −0.32). A significant indirect association (β = 0.13) indicated that lower stoicism explained part of the association between MI symptom severity and suicide risk. Younger age, divorce/separation/widowhood, and identifying as gender diverse were associated with higher suicide risk; holding a bachelor’s degree was associated with lower risk. Stoicism was associated with lower suicide risk and accounted for part of the association between MI symptom severity and suicide risk. Stoic appraisal styles may represent a promising target for veteran suicide prevention research.