Modeling PTSD Symptom Clusters, Alcohol Misuse, Anger, and Depression as They Relate to Aggression and Suicidality in Returning U.S. Veterans


  • Julianne C. Hellmuth is now at Department of Psychiatry, Yale University. Cynthia A. Stappenbeck is now at Department of Psychiatry and Behavioral Sciences, University of Washington.

  • This material is the result of work supported by resources from the VA Puget Sound Health Care System, Seattle, Washington, and the National Institute on Drug Abuse (T32DA019426).

Correspondence concerning this article should be addressed to Julianne C. Hellmuth, Department of Psychiatry, Division of Prevention and Community Research, 389 Whitney Ave., New Haven, CT 06511. E-mail:


Suicidal ideation and aggression are common correlates of posttraumatic stress disorder (PTSD) among U.S. Iraq and Afghanistan war veterans. The existing literature has established a strong link between these factors, but a more nuanced understanding of how PTSD influences them is needed. The current study examined the direct and indirect relationships between PTSD symptom clusters and suicidal ideation in general aggression (without a specified target) regarding depression, alcohol misuse, and trait anger. Participants were 359 (92% male) U.S. Iraq/Afghanistan war veterans. Path analysis results suggested that the PTSD numbing cluster was directly (β = .28, p < .01) and indirectly (β = .17, p = .001) related through depression. The PTSD hyperarousal cluster was indirectly related to suicidal ideation through depression (β = .13, p < .001). The PTSD reexperiencing cluster was directly related to aggression (β = .17, p < .05), whereas the PTSD numbing and hyperarousal clusters were indirectly related to aggression through trait anger (β = .05, p < .05; β = .20, p < .001). These findings indicate that adjunct treatments aimed at stabilizing anger, depression, and alcohol misuse may help clinicians ameliorate the maladaptive patterns often observed in veterans. These results also point to specific manifestations of PTSD and co-occurring conditions that may inform clinicians in their attempts to identify at risk veterans and facilitate preventative interventions.