Predicting Suicide Risk: The Role of Aggression

United States veterans are at increased risk of dying by suicide compared to non-veterans, with data indicating a consistent rise in deaths by suicide over the past two decades. Effective suicide prevention interventions are available, yet suicide rates remain inflated in the veteran population. The presence of aggressive behavior (AB) in this population may confer increased risk for suicidal ideation (SI) and behaviors. Prior research indicates that AB predicts future SI even after controlling for other significant risk factors and that the co-occurrence of SI and AB elicits increased risk of death by suicide above and beyond the presence of either tendency in isolation. No prior research has examined the degree to which AB has a direct effect on, or triggers episodes of SI, despite high rates of both AB and SI in the veteran population. Elucidating the temporal relationship between these two constructs may provide insight capable of improving existing risk assessment and prevention methods with the long-term goal of decreasing veteran suicide and violence. The overall aim of the proposed project is to apply ecological momentary assessment (EMA) methods to elucidate the real-time relationship between AB and SI in daily life. EMA methods are capable of directly examining the temporal association between AB and SI, their associated emotional processes, and whether those processes vary across subtypes of veterans with SI. The specific aims of the study are to: 1) examine the temporal association between AB and SI, 2) identify momentary emotional mechanisms that predict the occurrence of AB and SI, and 3) explore subtypes of individuals with distinct patterns of associations among emotions, AB, and SI. Veterans (N = 63) with a recent history of SI will be enrolled in the study. At study enrollment participants will complete questionnaires capturing constructs associated with instances of AB and SI. Participants will then complete a four-week EMA protocol during which they will complete 5 daily pseudorandom assessment instances capturing momentary emotional experiences, AB, and SI. Substance use, sleep quality, and experiences of pain will be measured as within-person covariates. The long-term goals of the project are to improve our ability to identify those at greatest risk of suicide and aggressive behavior so that those outcomes can be prevented. A comprehensive training plan will enable the applicant to conduct the proposed research and receive individualized training to facilitate his development as an independent investigator. Through the mentorship and training activities provided by this CDA, the applicant will: 1) build content area expertise in the best practices for suicide and interpersonal violence research, risk management, and safety planning; 2) develop methodological expertise in the design and implementation of EMA research; 3) develop expertise in multilevel intensive longitudinal data analytic methods. The applicant’s training plan is an excellent fit with the career development opportunities offered by the National Center for PTSD and Suicide Prevention Research Impact Network within the VA Boston Healthcare System. The training plan complements and augments the proposed research, and includes individual mentorship from experts in veteran suicidality, aggression, and EMA data collection and analysis: Drs. Brian Marx (primary mentor), Casey Taft (co-mentor), Nathan Kimbrel (co- mentor), and Nicholas Livingston (co-mentor). Findings from the proposed project will be used to inform a Merit application with the long-term goal of reducing veteran violent and suicidal behaviors. Project Number: 1IK2CX002823-01A1 | Fiscal Year: 2026 | NIH Institute/Center: Veterans Affairs (VA) | Principal Investigator: Michael Crowe | Institution: VA BOSTON HEALTH CARE SYSTEM, BOSTON, MA | Activity Code: IK2 | Study Section: Special Emphasis Panel[ZRD1 MHBC-F (01)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11048131