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The factor structure of psychiatric comorbidity among Iraq/Afghanistan-era veterans and its relationship to violence, incarceration, suicide attempts, and suicidality.
Kimbrel NA, Calhoun PS, Elbogen EB, Brancu M, VA Mid-Atlantic MIRECC Registry Workgroup, Beckham JC. The factor structure of psychiatric comorbidity among Iraq/Afghanistan-era veterans and its relationship to violence, incarceration, suicide attempts, and suicidality. Psychiatry Research. 2014 Dec 15; 220(1-2):397-403.
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.