Exposure to Civilian Casualties Is Related to Guilt and Suicidality in Post 9/11 Veterans of Iraq and Afghanistan

Abstract The nature of America’s Post 9/11 wars has often placed service members in close proximity to not only enemy and friendly forces, but also civilian noncombatants. The unique psychological consequences of witnessing, attempting to save, or feeling responsible for causing harm to noncombatants are relatively understudied. However, guilt has been shown to be both a direct predictor of suicidal ideation and also to act as a moderator and mediator in the relationship between trauma exposure and suicidality. Despite its established importance, there are few studies attempting to quantitatively explain the specific sources of guilt for combat veterans who may have been exposed to multiple and varied traumas. This study used a hierarchical multiple regression of self-report online survey data from Post 9/11 veterans of Iraq and/or Afghanistan (n = 184) to test the hypothesis that combat experiences with civilian casualties would predict guilt above and beyond other personal, military, and deployment characteristics and experiences. The results show a strong correlation between guilt and suicide and a moderate association between experiences involving civilian casualties and guilt. Additionally, feeling personally responsible for killing or wounding civilian noncombatants results in stronger feelings of guilt than either witnessing or providing medical assistance to them. The outcome of this study offers insights for tailoring interventions for veterans who report having combat experiences involving civilian casualties in order to improve how we address guilt and suicide risk. In doing so, the field may provide more comprehensive and relevant mental health support to combat veterans.