Moral injury, perceived burdensomeness, thwarted belongingness, and suicidal ideation in post-9/11 US combat veterans

Background: Moral injury – the psychological harm resulting from acts of wrongdoing or betrayals – correlates with negative psychosocial outcomes, including increased suicide risk. The Interpersonal Theory of Suicide (IPTS) suggests that perceived burdensomeness (the belief that one is a burden to others), and thwarted belongingness (psychological pain from unmet social connectedness) confer risk of suicidal ideation.Objective: The current study evaluates the degree to which perceived burdensomeness and thwarted belongingness mediates the associations of acts of wrongdoing and betrayal with current suicidal ideation.Method: We used a generative modelling approach with Bayesian latent variable models in a sample of 312 United States combat-deployed veterans.Results: Acts of wrongdoing were (1) directly associated with current suicidal ideation, with small effect (β = 0.15, 95% credible interval (CI): −0.01, 0.30); (2) indirectly associated via perceived burdensomeness, with small effect (β = 0.14, 95% CI: 0.06, 0.24); and (3) indirectly associated with thwarted belongingness, with negligible effect (β = 0.04, 95% CI: 0.00, 0.10). Acts of betrayal had negligible associations with current suicidal ideation.Conclusions: Feelings of burdensomeness warrant further investigation as a potential clinical target for veterans with moral injury exposure. Thwarted belongingness may be less potent, although measurement error complicates its interpretation.