Shame Drives Suicidal Ideation Among Veterans With PTSD

The authors argue that these findings suggest that reducing shame among veterans with post-traumatic stress disorder may reduce the risk for suicide.

Shame is an important risk factor for suicidal ideation in veterans with post-traumatic stress disorder (PTSD), according to the results of a study published in the Journal of Affective Disorders.

Every day, approximately 20 veterans die by suicide and up to 14% of veterans report current suicidal ideation. Veterans suffer disproportionately from mental health disorders, including PTSD, depression, and substance abuse. Up to 15% of veterans have PTSD, and those diagnosed with this disorder have high rates of suicidal behavior and suicide. Emotional responses to trauma have been shown to play an important role in PTSD and may increase the risk for suicidal behavior. Given the high rate of suicide among veterans, there is a pressing need to identify risk factors for suicidal behavior.

Katherine C. Cunningham, PhD, from the Durham Veterans Affairs Medical Center and the VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, and colleagues investigated the role of that shame plays in PTSD and suicidal ideation. They used the Mississippi Scale for Combat-Related PTSD to gauge PTSD severity, the Personality Assessment Inventory to evaluate suicidal ideation, and the Internalized Shame Scale to assess shame among 189 men and 12 women who were veterans, with a mean age of 40 years. Whites made up 48.3% of the study population, blacks made up 44.8%, Native Americans 2%, white Hispanics 3%, and others 2%.

PTSD and shame together accounted for a significant degree of the variance in suicidal ideation. However, although shame had significant effects on both suicidal ideation and PTSD, and PTSD had an indirect effect on suicidal ideation via shame, shame did not have an indirect effect on suicidal ideation via PTSD symptoms. The authors suggest that these findings indicate that shame drives the relationship between PTSD and suicidal ideation.

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The study is limited by the cross-sectional nature of the data, which restricts the ability to establish causality, and the fact that all participants were veterans, and most were men.

The authors argue that these findings suggest that reducing shame among veterans with PTSD may reduce the risk for suicide. They call for increased focus on shame in both research and clinical practice in veterans with PTSD and suicidal ideation.


Cunningham KC, LoSavio ST, Dennis PA, et al. Shame as a mediator between posttraumatic stress disorder symptoms and suicidal ideation among veterans. J Affect Disord. 2019;15(243):216-219.