Negative cognition in the context of suicidality after exposure to military-related potentially morally injurious events

Introduction: Consistent associations are found between exposure to potentially morally injurious events (PMIEs) and suicidal thoughts and behaviours (STBs). Studies examining cognitions after PMIEs have focused on those describing one's role in the event (e.g., "I did something wrong") rather than those describing sense of self (e.g., "I am a bad person"). Stable internal attributions (e.g., "I did a bad thing because I'm a bad person") are shown to be particularly psychologically harmful; therefore, this is an important limitation. The study explored differences in negative cognitions in those reporting and not reporting STBs after a PMIE. Methods: This study is a secondary analysis of data from a treatment-seeking sample of Canadian military members and Veterans reporting distress after a PMIE (N = 55). Participants completed clinician-administered interviews on STBs and questionnaires measuring negative cognitions. Results: More than half (n = 30) of participants endorsed current STBs, and 20.0% (n = 11) reported previously attempting suicide. There were no differences in cognitions related to hindsight/responsibility, wrongdoing, lack of justification, self-blame, or negative cognitions about the world. Participants with STBs reported more negative cognitions about the self than those without current STBs. Discussion: Results suggest that negative cognitions focusing on stable features of the self, rather than on events, may be more important in their association with STBs after a PMIE. This is consistent with the notion that shame, rather than guilt, is more problematic in psychopathology and STBs. LAY SUMMARYMoral injury (MI) refers to the psycho-spiritual consequences of events that deeply transgress a person's core moral beliefs and values. Such events are reportedly common in the military context, and strong associations have been demonstrated between exposure to potentially morally injurious events (PMIEs) and suicidality. This study explored differences in negative cognitions between treatment-seeking Canadian Armed Forces members and Veterans with and without current suicidal thoughts and behaviours (STBs), all of whom reported current distress in response to a PMIE. Those exhibiting STBs reported stronger negative beliefs about the self. Scores for event-related guilt cognitions and self-blame were similar across individuals with and without STBs. Individuals reporting STBs also displayed higher depression and symptoms of posttraumatic stress disorder. The results suggest that severity of mental health symptoms and negative self-evaluations may be most pertinent in their association with suicidality in the MI context. Results remain preliminary, however, and additional research is needed to properly examine how event and self-related evaluations affect suicidality after PMIEs.