Love Is Not All You Need: Understanding the Association Between Relationship Status and Relationship Dysfunction With Self-Directed Violence in Veterans

Abstract

Introduction

Research indicates that being married is associated with reduced risk of suicide and self-directed violence (SDV) relative to being divorced. Simultaneously, difficulties within relationships predict poorer health outcomes. However, research on relationship status rarely examines relationship functioning, obfuscating the joint contribution of these variables for SDV risk.

Method

Veterans (N = 1,049) completed a survey that included assessment of relationship status, relationship functioning, and SDV history. Logistic regression models tested how (a) relationship status, (b) relationship dysfunction, and (c) being divorced compared to being in a low- or high-dysfunction relationship were associated with SDV, controlling for several intrapersonal risk factors.

Results

Veterans in a relationship did not differ in SDV history compared to divorced/separated veterans. However, more dysfunction within relationships was associated with greater odds of a history of SDV and suicidal cognitions. Finally, SDV histories were more likely among veterans endorsing high-dysfunction relationships compared with (a) low-dysfunction relationships and (b) divorced veterans.

Conclusion

It may be insufficient to only consider relationship status when evaluating interpersonal risk factors for SDV. A single item assessing relationship dysfunction was associated with enacted SDV and suicidal cognitions over and above intrapersonal risk factors. Integrating such single-item measures into clinical practice could improve identification and subsequent tailored intervention for veterans at greater risk for SDV.

HIGHLIGHTS

• Relationship dysfunction was related to self-directed violence (SDV) history independent of other risk factors.

• Being in a relationship alone was not related to SDV history relative to being divorced.

• A single item assessing relationship dysfunction was related to SDV history.

Keywords:

• Marital status
• NSSI
• relationships
• relationship functioning
• self-directed violence
• suicide

CONTRIBUTORS

Danielle M. Weber contributed to conceptualization, formal analysis, and writing of the original draft. Tate F. Halverson contributed to writing of the original draft, and review and editing. Samantha E. Daruwala contributed to review and editing. Mary J. Pugh contributed to funding acquisition and review and editing. Patrick S. Calhoun contributed to review and editing. Jean C. Beckham contributed to supervision, resources, and review and editing. Nathan A. Kimbrel contributed to conceptualization, formal analysis, funding acquisition, review and editing, supervision.

ROLE OF FUNDING SOURCE

This research was supported by VA Grant No. 1I01HX001682 awarded to Drs. Kimbrel and Pugh. Dr. Halverson was supported by a VA Office of Academic Affiliations Advanced Fellowship in Mental Illness Research and Treatment. Dr. Beckham was funded by a Senior Research Career Scientist award from VA Clinical Sciences Research and Development (No. IK6BX00377). Dr. Pugh was funded by a Research Career Scientist Award from VA Health Services Research and Development (No. IK6HX002608).

ACKNOWLEDGEMENT

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the United States Government or Department of Veterans Affairs (VA).

CONFLICT OF INTEREST

All authors declare that they have no conflicts of interest.

AUTHOR NOTE

Danielle Weber, PhD, Durham Veterans Affairs Health Care System, Durham, NC, USA; Department of Psychology, University of Georgia, Athens, GA, USA. Tate Halverson, PhD, Durham Veterans Affairs Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA. Samantha Daruwala, PhD, Durham Veterans Affairs Health Care System, Durham, NC, USA; School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA. Mary Jo Pugh, PhD, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA; Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA. Patrick Calhoun, PhD, Durham Veterans Affairs Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA. Jean Beckham, PhD, Durham Veterans Affairs Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA. Nathan Kimbrel, PhD, Durham Veterans Affairs Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA.

Notes

1 Because there were more instances of missing data for a separate item assessing gender identity, sex assigned at birth was used as the control variable as opposed to gender. Importantly, sex assigned at birth and gender identity in the present sample were very highly correlated (r = .99, p < .001). Owing to small sample sizes for certain racial categories, race was separated into three categories: White, Black, and other person of color. See Table 1 for breakdown of complete demographics.

Additional information

Funding

This work was supported by Office of Research and Development and VA Office of Academic Affiliations.