Abstract
Intimate relationship distress has been identified as one of the most common precipitants of suicidal thoughts for U.S. military populations. Sexual functioning is associated with relationship distress and has recently been identified as a predictor of suicidal ideation with female military personnel; however, no studies have examined this association among a treatment-seeking sample of male and female veterans and their partners. Couples (N = 138) completed baseline assessments of sexual functioning, relationship functioning, suicidal ideation, and mental health prior to evaluation for engagement in a couples-based PTSD treatment study. Analyses revealed that decreased sexual pleasure and decreased frequency of sexual intercourse were associated with more recent suicidal ideation for male veterans, whereas increased sexual frequency was marginally associated with increased suicidal ideation for female veterans, controlling for PTSD and depression symptoms, relationship satisfaction, and medications. These findings stress the importance of assessing sexual functioning as a risk factor for suicide and taking into consideration the possibility that sexual functioning may be protective or predictive of suicidality depending on the person and context.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Ashbaugh, A. R., Houle-Johnson, S., Herbert, C., El-Hage, W., & Brunet, A. (2016). Psychometric validation of the English and French versions of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). PLoS ONE,11(10), e0161645. https://doi.org/10.1371/journal.pone.0161645.
Badour, C. L., Gros, D. F., Szafranski, D. D., & Acierno, R. (2015). Problems in sexual functioning among male OEF/OIF veterans seeking treatment for posttraumatic stress. Comprehensive Psychiatry,58, 74–81. https://doi.org/10.1016/j.comppsych.2014.12.012.
Baumeister, R. F., & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin,117, 497–529. https://doi.org/10.1037/0033-2909.117.3.497.
Beautrais, A. L., Joyce, P. R., & Mulder, R. T. (1997). Precipitating factors and life events in serious suicide attempts among youths aged 13 through 24 years. Journal of the American Academy of Child and Adolescent Psychiatry,36(11), 1543–1551. https://doi.org/10.1016/S0890-8567(09)66563-1.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.
Birnbaum, G., & Finkel, E. (2015). The magnetism that holds us together: Sexuality and relationship maintenance across relationship development. Current Opinion in Psychology, 1, 29–33. https://doi.org/10.1016/j.copsyc.2014.11.009.
Blais, R. K., Monteith, L. L., & Kugler, J. (2018). Sexual dysfunction is associated with suicidal ideation in female service members and veterans. Journal of Affective Disorders,226, 52–57. https://doi.org/10.1016/j.jad.2017.08.079.
Blanchflower, D. G., & Oswald, A. J. (2004). Money, sex and happiness: An empirical study. Scandinavian Journal of Economics,106, 393–415. https://doi.org/10.1111/j.0347-0520.2004.00369.x.
Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress,28(6), 489–498. https://doi.org/10.1002/jts.22059.
Centers for Disease Control and Prevention. (2016). Web-based Injury Statistics Query and Reporting System (WISQARS). Retrieved from www.cdc.gov/injury/wisqars/index.html. Accessed 8 Nov 2018.
Cheng, Z., & Smyth, R. (2015). Sex and happiness. Journal of Economic Behavior & Organization,112, 26–32. https://doi.org/10.1016/j.jebo.2014.12.030.
Cicila, L. N. (2016). Trajectories of sexual satisfaction in the context of couple therapy (Doctoral dissertation). Retrieved from ProQuest Dissertations Publishing. (10154855).
Cosgrove, D. J., Gordon, Z., Bernie, J. E., Hami, S., Montoya, D., Stein, M. B., & Monga, M. (2002). Sexual dysfunction in combat veterans with post-traumatic stress disorder. Urology,60, 881–884. https://doi.org/10.1016/S0090-4295(02)01899-X.
Deci, E. L., & Ryan, R. M. (2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry,11, 227–268. https://doi.org/10.1207/S15327965PLI1104_01.
Department of Veterans Affairs. (2018). Veteran suicide data report, 2005-2016. Retrieved from https://www.mentalhealth.va.gov/docs/data-sheets/OMHSP_National_Suicide_Data_Report_2005-2016_508-compliant.pdf. Accessed 4 Jan 2019.
Fitzpatrick, J., Gareau, A., Lafontaine, M. F., & Gaudreau, P. (2016). How to use the Actor-Partner Interdependence Model (APIM) to estimate different dyadic patterns in MPLUS: A step-by-step tutorial. Quantitative Methods for Psychology,12(1), 74–86. https://doi.org/10.20982/tqmp.12.1.p074.
Friedlander, A., Nazem, S., Fiske, A., Nadorff, M. R., & Smith, M. D. (2012). Self-concealment and suicidal behaviors. Suicide and Life-Threatening Behavior,42(3), 332–340. https://doi.org/10.1111/j.1943-278X.2012.00094.x.
Funk, J. L., & Rogge, R. D. (2007). Testing the ruler with item response theory: Increasing precision of measurement for relationship satisfaction with the Couples Satisfaction Index. Journal of Family Psychology,21(4), 572–583. https://doi.org/10.1037/0893-3200.21.4.572.
Garcia, R. L., Kenny, D. A., & Ledermann, T. (2015). Moderation in the actor-partner interdependence model. Personal Relationships,22(1), 8–29. https://doi.org/10.1111/pere.12060.
Hirsch, K. A. (2009). Sexual dysfunction in male Operation Enduring Freedom/Operation Iraqi Freedom patients with severe post-traumatic stress disorder. Military Medicine,174(5), 520–522. https://doi.org/10.7205/MILMED-D-03-3508.
Jakupcak, M., Cook, J., Imel, Z., Fontana, A., Rosenheck, R., & McFall, M. (2009). Posttraumatic stress disorder as a risk factor for suicidal ideation in Iraq and Afghanistan war veterans. Journal of Traumatic Stress,22(4), 303–306. https://doi.org/10.1002/jts.20423.
Joiner, T. E. (2007). Why people die by suicide. Cambridge, MA: Harvard University Press.
Kashdan, T. B., Adams, L. M., Farmer, A. S., Ferssizidis, P., McKnight, P. E., & Nezlek, J. B. (2014). Sexual healing: Daily diary investigation of the benefits of intimate and pleasurable sexual activity in socially anxious adults. Archives of Sexual Behavior,43, 1417–1429. https://doi.org/10.1007/s10508-013-0171-4.
Kashdan, T. B., Goodman, F. R., Stiksma, M., Milius, C. R., & McKnight, P. E. (2018). Sexuality leads to boosts in mood and meaning in life with no evidence for the reverse direction: A daily diary investigation. Emotion,18(4), 563–576. https://doi.org/10.1037/emo0000324.
Keller, A., McGarvey, E. L., & Clayton, A. H. (2006). Reliability and construct validity of the Changes in Sexual Functioning Questionnaire Short-Form (CSFQ-14). Journal of Sex and Marital Therapy,32, 43–52. https://doi.org/10.1080/00926230500232909.
Kenny, D. A., Kashy, D. A., & Cook, W. L. (2006). Dyadic data analysis. New York, NY: Guilford Press.
Kleiman, E. M., & Beaver, J. K. (2013). A meaningful life is worth living: Meaning in life as a suicide resiliency factor. Psychiatry Research,210(3), 934–939. https://doi.org/10.1016/j.psychres.2013.08.002.
Kleiman, E. M., Law, K. C., & Anestis, M. D. (2014). Do theories of suicide play well together? Integrating components of the hopelessness and interpersonal psychological theories of suicide. Comprehensive Psychiatry,55(3), 431–438. https://doi.org/10.1016/j.comppsych.2013.10.015.
Klonsky, E. D., May, A. M., & Saffer, B. Y. (2016). Suicide, suicide attempts, and suicidal ideation. Annual Review of Clinical Psychology,12, 307–330. https://doi.org/10.1146/annurev-clinpsy-021815-093204.
Klonsky, E. D., & May, A. M. (2015). The three-step theory (3ST): A new theory of suicide rooted in the “ideation-to-action” framework. International Journal of Cognitive Therapy, 8, 114–129.
Lambert, N. M., Stillman, T. F., Hicks, J. A., Kamble, S., Baumeister, R. F., & Fincham, F. D. (2013). To belong is to matter: Sense of belonging enhances meaning in life. Personality and Social Psychology Bulletin, 39(11), 1418–1427. https://doi.org/10.1177/0146167213499186.
Laumann, E. O., Paik, A., Glasser, D. B., Kang, J. H., Wang, T., Levinson, B., … Gingell, C. (2006). A cross-national study of subjective sexual well-being among older women and men: Findings from the Global Study of Sexual Attitudes and Behaviors. Archives of Sexual Behavior,35(2), 143–161. https://doi.org/10.1007/s10508-005-9005-3.
Litzinger, S., & Gordon, K. C. (2005). Exploring relationships among communication, sexual satisfaction, and marital satisfaction. Journal of Sex and Marital Therapy,31(5), 409–424. https://doi.org/10.1080/00926230591006719.
Martin, J. S., Ghahramanlou-Holloway, M., Englert, D. R., Bakalar, J. L., Olsen, C., Nademin, E. M., … Branlund, S. (2013). Marital status, life stressor precipitants, and communications of distress and suicide intent in a sample of United States Air Force suicide decedents. Archives of Suicide Research,17(2), 148–160. https://doi.org/10.1080/13811118.2013.776456.
McCall-Hosenfeld, J. S., Liebschutz, J. M., Spirolll, A., & Seaber, M. R. (2009). Sexual assault in the military and its impact on sexual satisfaction in women veterans: A proposed model. Journal of Women’s Health,18(6), 593–595. https://doi.org/10.1089/jwh.2008.0987.
Monteith, L. L., Menefee, D. S., Pettit, J. W., Leopoulos, W. L., & Vincent, J. P. (2013). Examining the interpersonal–psychological theory of suicide in an inpatient veteran sample. Suicide and Life-Threatening Behavior,43(4), 418–428. https://doi.org/10.1111/sltb.12027.
Morland, L., Macdonald, A., Grubbs, K. M., Mackintosh, M. A., Monson, C., Glassman, L., … Wells, S. Y. (2019). Design of a randomized superiority trial of a brief couple treatment for PTSD. Contemporary Clinical Trials Communications, 100369. https://doi.org/10.1016/j.conctc.2019.100369.
Nock, M. K., & Banaji, M. R. (2007). Prediction of suicide ideation and attempts among adolescents using a brief performance-based test. Journal of Consulting and Clinical Psychology,75(5), 707. https://doi.org/10.1037/0022-006X.75.5.707.
Nock, M. K., Deming, C. A., Fullerton, C. S., Gilman, S. E., Goldenberg, M., Kessler, R. C., … Ursano, R. J. (2013). Suicide among soldiers: A review of psychosocial risk and protective factors. Psychiatry: Interpersonal and Biological Processes,76(2), 97–125. https://doi.org/10.1521/psyc.2013.76.2.97.
Perlman, C. M., Martin, L., Hirdes, J. P., Curtin-Telegdi, N., Pérez, E., & Rabinowitz, T. (2007). Prevalence and predictors of sexual dysfunction in psychiatric inpatients. Psychosomatics,48(4), 309–318. https://doi.org/10.1176/appi.psy.48.4.309.
Ramsawh, H. J., Fullerton, C. S., Herberman Mash, H. B., Ng, T. H. H., Kessler, R. C., Stein, M. B., & Ursano, R. J. (2014). Risk for suicidal behaviors associated with PTSD, depression, and their comorbidity in the U.S. Army. Journal of Affective Disorders,161, 116–122. https://doi.org/10.1016/j.jad.2014.03.016.
Robustelli, B. L., Trytko, A. C., Li, A., & Whisman, M. A. (2015). Marital discord and suicidal outcomes in a national sample of married individuals. Suicide and Life-Threatening Behavior,45(5), 623–632. https://doi.org/10.1111/sltb.12157.
Rosebrock, L., & Carroll, R. (2017). Sexual function in female veterans: A review. Journal of Sex and Marital Therapy,42(3), 228–245. https://doi.org/10.1080/0092623X.2016.1141822.
Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., … D’Agostino, R. (2000). The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex and Marital Therapy,26(2), 191–208. https://doi.org/10.1080/009262300278597.
Schreiner-Engel, P., & Schiavi, R. C. (1986). Lifetime psychopathology in individuals with low sexual desire. Journal of Nervous and Mental Disease,174(11), 646–651. https://doi.org/10.1097/00005053-198611000-00002.
Skopp, N. A., Holland, K. M., Logan, J. E., Alexander, C. L., & Floyd, C. F. (2018). Circumstances preceding suicide in U.S. soldiers: A qualitative analysis of narrative data. Psychological Services, 16, 302–311. https://doi.org/10.1037/ser0000221.
Street, A. E., Vogt, D., & Dutra, L. (2009). A new generation of women veterans: Stressors faced by women deployed to Iraq and Afghanistan. Clinical Psychology Review,29(8), 685–694. https://doi.org/10.1016/j.cpr.2009.08.007.
Sveen, J., Bondjers, K., & Williebrand, M. (2015). Psychometric properties of the PTSD Checklist for DSM-5: A pilot study. European Journal of Psychotraumatology,7(1), 30165. https://doi.org/10.3402/ejpt.v7.30165.
Turchik, J. A., Pavao, J., Nazarian, D., Iqbal, S., McLean, C., & Kimerling, R. (2012). Sexually transmitted infections and sexual dysfunctions among newly returned veterans with and without military sexual trauma. International Journal of Sexual Health,24(1), 45–59. https://doi.org/10.1080/19317611.2011.639592.
U. S. Department of Health and Human Services. (2010). Women’s health USA 2010. Retrieved from http://mchb.hrsa.gov/whusa10/popchar/pages/109wv.html. Accessed 8 Nov 2019.
U. S. Department of Veterans Affairs. (2011). Women veterans health care. The changing face of women veterans, 2011. Retrieved from www.womenshealth.va.gov/facts.asp. Accessed 12 Dec 2018.
Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at www.ptsd.va.gov. Accessed 12 Dec 2018.
Wilks, C. R., Morland, L. A., Dillon, K. H., Mackintosh, M. A., Blakey, S. M., Wagner, H. R., … Elbogen, E. B. (2018). Anger, social support, and suicide risk in U.S. military veterans. Journal of Psychiatric Research,109, 139–144. https://doi.org/10.1016/j.jpsychires.2018.11.026.
Wilson, L. C. (2016). The prevalence of military sexual trauma: A meta-analysis. Trauma, Violence and Abuse,11, 1–14. https://doi.org/10.1177/1524838016683459.
World Health Organization. (2018). Suicide prevention (SUPRE). Retrieved from www.who.int/mental_health/prevention/suicide/suicideprevent/en/. Accessed 4 Jan 2019.
Yehuda, R., Lehrner, A., & Rosenbaum, T. (2015). PTSD and sexual dysfunction in men and women. Journal of Sexual Medicine,12, 1107–1119. https://doi.org/10.1111/jsm.12856.
Acknowledgements
Funding was provided by Rehabilitation Research and Development Service Award D2093-R.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed in the studies involving human participants were in accordance with the ethical standard of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in this study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Khalifian, C.E., Knopp, K., Wilks, C.R. et al. The Association Between Sexual Functioning and Suicide Risk in U.S. Military Veteran Couples Seeking Treatment for Post-Traumatic Stress Disorder. Arch Sex Behav 49, 1601–1613 (2020). https://doi.org/10.1007/s10508-019-01577-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-019-01577-x