Participation in personally meaningful activities mediates the relationship between multimorbidity and suicidal ideation among post-9/11 Veterans

Abstract: Background: United States veterans who served after September 11, 2001 (i.e., post-9/11) frequently experience multimorbidity, the presence of two or more chronic health conditions. Common multimorbidity clusters in this veteran cohort include mental health conditions and the polytrauma clinical triad (i.e., traumatic brain injury, posttraumatic stress disorder, and pain). Previous research has demonstrated veterans with multimorbidity are more likely to also experience suicidal ideation, although the underlying mechanism is unclear. The objective of the present study was to determine if decreased participation in life activities mediated the relationship between multimorbidity and suicidal ideation. Methods: This was an analysis of data from 8063 veterans who participated in the Comparative Health Assessment Interview Research Study, a national survey of post-9/11 veterans. Multimorbidity clusters were identified using latent class analysis. The relationships between multimorbidity clusters and suicidal ideation were estimated with path analysis, with participation in multiple life activities included as potential mediators. Results: Latent class analysis identified a Healthy cluster and three multimorbidity clusters: Mental & Behavioral Health; Traumatic Brain Injury and Musculoskeletal Disorder; and Polytrauma Clinical Triad and Depression. Multimorbidity clusters were associated with a greater likelihood of suicidal ideation. Participation in personally meaningful activities mediated the relationships between multimorbidity clusters and suicidal ideation. Conclusions: Multimorbidity is associated with reduced participation in personally meaningful activities, which in turn is associated with increased risk for suicidal ideation. Interventions that promote participation in activities that are consistent with the values and interests of veterans with multimorbidity may protect against suicidal ideation.

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