Seediscussions,stats,andauthorprofilesforthispublicationat:https://www.researchgate.net/publication/313537465

TheImpactofAggressionontheRelationshipBetweenBetrayalandBelongingnessAmongU.S.MilitaryPersonnel.

ArticleinMilitaryPsychology·February2017

DOI:10.1037/mil0000160

CITATIONS

0

READS

73

6authors,including:

Someoftheauthorsofthispublicationarealsoworkingontheserelatedprojects:

TheMinnesotaMultiphasicPersonalityInventory-2-RestructuredForm(MMPI-2-RF)inaSampleof

IndividualsinTreatmentforSexualAddictionViewproject

PopulationHealthandSocialMediaViewproject

AnnaBelleOdetteBryan

UniversityofUtah

26PUBLICATIONS181CITATIONS

SEEPROFILE

CraigJBryan

UniversityofUtah

157PUBLICATIONS2,325CITATIONS

SEEPROFILE

BradleyAGreen

UniversityofSouthernMississippi

54PUBLICATIONS885CITATIONS

SEEPROFILE

MichaelDAnestis

UniversityofSouthernMississippi

115PUBLICATIONS2,310CITATIONS

SEEPROFILE

AllcontentfollowingthispagewasuploadedbyRachelLynnMartinon04April2017.

Theuserhasrequestedenhancementofthedownloadedfile.

Military PsychologyThe Impact of Aggression on the Relationship BetweenBetrayal and Belongingness Among U.S. MilitaryPersonnelRachel L. Martin, Claire Houtsma, AnnaBelle O. Bryan, Craig J. Bryan, Bradley A. Green, and MichaelD. AnestisOnline First Publication, February 9, 2017. http://dx.doi.org/10.1037/mil0000160

CITATIONMartin, R. L., Houtsma, C., Bryan, A. O., Bryan, C. J., Green, B. A., & Anestis, M. D. (2017, February9). The Impact of Aggression on the Relationship Between Betrayal and Belongingness AmongU.S. Military Personnel. Military Psychology. Advance online publication.http://dx.doi.org/10.1037/mil0000160

The Impact of Aggression on the Relationship Between Betrayaland Belongingness Among U.S. Military Personnel

Rachel L. Martin and Claire HoutsmaUniversity of Southern Mississippi

AnnaBelle O. Bryan and Craig J. BryanNational Center for Veterans Studies, Salt Lake

City, Utah, and The University of Utah

Bradley A. Green and Michael D. AnestisUniversity of Southern Mississippi

The suicide rate among U.S. military personnel, particularly within the Army NationalGuard, is significantly higher than the rate found among the general population. Tobetter understand why the Army National Guard has elevated rates of suicide, thecurrent study examined how deployment-related moral injury interacts with interper-sonal factors to predict suicide risk. Specifically, this study hypothesized that deploy-ment-related betrayal, a facet of the Moral Injury Events Scale, would predict thwartedbelongingness and that this relationship would be moderated by several types ofaggression (physical aggression, verbal aggression, hostility, and anger). The currentsample comprised 562 military personnel who had experienced at least 1 previousdeployment. Results revealed that betrayal predicted thwarted belongingness in thepresence of high but not low or mean levels of aggression among military personnel.This indicates that aggressive individuals who experience perceived betrayal whiledeployed may be at high risk for development of thwarted belongingness, an importantrisk factor for suicide. These results suggest the need for better assessment andtreatment of betrayal among military personnel, as well as the need for programs to helpsoldiers manage aggression.

Keywords: suicide, military, betrayal, aggression

Until 2009, membership in the military ap-peared to confer some degree of protectionagainst the development of suicidal ideation and

suicidal behavior, yet suicide rates among thearmed forces have dramatically increased(Nock et al., 2013). In recent years, militarysuicide rates have continued to rise, despitegrowing awareness and research (National Cen-ter for Telehealth and Technology, DefenseCenters for Psychological Health [NCTT],2014). The Army National Guard has the high-est suicide rate of all branches and componentsof the military (33.4 per 100,000; NCTT, 2014),78.6% higher than the rate among active dutymilitary personnel (18.7 per 100,000; NCTT,2014). When compared to that of men 20–29years of age in the general population (23.4 per100,000; Centers for Disease Control and Pre-vention, 2013), the suicide rate among ArmyNational Guard military personnel is 42.7%higher. The elevated suicide rate of the NationalGuard has been a concern among researcherssince it surpassed that of the active duty military(Griffith, 2012a, 2012b; Kline, Ciccone, Falca-Dodson, Black, & Losonczy, 2011). One poten-

Rachel L. Martin and Claire Houtsma, Department of Psychol-ogy, University of Southern Mississippi; AnnaBelle O. Bryan andCraig J. Bryan, National Center for Veterans Studies, Salt LakeCity, Utah, and Department of Psychology, The University ofUtah; Bradley A. Green and Michael D. Anestis, Department ofPsychology, University of Southern Mississippi.

This work was in part supported by the Military SuicideResearch Consortium (MSRC), an effort supported by theOffice of the Assistant Secretary of Defense for HealthAffairs under Award W81XWH-10-2–0181. Opinions, in-terpretations, conclusions, and recommendations are thoseof the authors’ and are not necessarily endorsed by theMSRC or the Department of Defense.

Correspondence concerning this article should be ad-dressed to Michael D. Anestis, Department of Psychology,University of Southern Mississippi, Owings-McQuaggeHall 231, 118 College Drive, #5025, Hattiesburg, MS39406. E-mail: michael.anestis@usm.edu

Thi

sdo

cum

ent

isco

pyri

ghte

dby

the

Am

eric

anPs

ycho

logi

cal

Ass

ocia

tion

oron

eof

itsal

lied

publ

ishe

rs.

Thi

sar

ticle

isin

tend

edso

lely

for

the

pers

onal

use

ofth

ein

divi

dual

user

and

isno

tto

bedi

ssem

inat

edbr

oadl

y.

Military Psychology © 2017 American Psychological Association2017, Vol. 29, No. 2, 000 0899-5605/17/$12.00 http://dx.doi.org/10.1037/mil0000160

1

tial explanation for the elevated suicide risk inthe National Guard is that, in contrast to mili-tary personnel in the active duty components,National Guard personnel separate from theirunit after deployment. As such, interpersonalrelationships may be strained with respect toboth civilian and military life. If this is indeedthe case, understanding specific vulnerabilitiesto interpersonal distress—particularly suicide-relevant interpersonal distress—is paramount.This study thus aims to determine to what extentspecific military experiences are associated withinterpersonal risk factors for suicide and, addi-tionally, to what extent any such association isimpacted by the response styles of the soldier.

Suicide risk appears particularly pronouncedin certain military subpopulations. For example,previously deployed military personnel ac-counted for 66.5% of military deaths by suicidein the year 2013 (NCTT, 2014). Elevated sui-cide rates among the Army National Guard andamong military personnel with previous deploy-ment(s) highlight the need for improved under-standing of what increases suicide risk for theseindividuals. Recently, military suicide research-ers have increased efforts to explore soldiers’specific experiences during deployment andtheir effect on suicide risk (C. J. Bryan, 2015).One potentially fruitful variable to consider inthis regard could be deployment-based betrayal,which is considered one component of moralinjury. As a construct, moral injury was firstdefined as events “such as perpetrating, failingto prevent, or bearing witness to acts that trans-gress deeply held moral beliefs and expecta-tions” (Litz et al., 2009, p. 697). Nash andcolleagues (2013) developed the Moral InjuryEvents Scale (MIES) to systematically measuremoral injury. This scale identifies two elementsof moral injury: perceived transgressions (actsof commission or omission done by self orothers) and perceived betrayals by others. Pre-vious research has shown that veterans whoquestion their moral integrity during battle iden-tify with emotions such as alienation, loneli-ness, and abandonment (Doka, 2002; Fiala,2008; Harvey, 2002; Kauffmann, 2002; Shay,1994). Such findings indicate that the experi-ence of moral injury during deployment maylead to the development of isolation and sub-stantially interfere with interpersonal relation-ships. Prior work considering moral injury andits association with suicide risk has focused

primarily on transgressions (self and other);however, given the importance of social supportand reciprocal relationships in suicide risk, be-trayal—and the potential interpersonal distressit could cause—may represent an importantvariable to consider. Betrayal, which assesses“internal conflict due to perceived duplicity ordeceit by military leaders, fellow service mem-bers, and individuals external to the military,”has been shown to have unique characteristicsseparate from perceived transgressions due toits involvement of interpersonal distress (C. J.Bryan et al., 2016, p. 559; Nash et al., 2013).

Research among Vietnam veterans revealedbetrayal as a constant theme throughout veter-ans’ combat experiences (McCormack & Jo-seph, 2014). The veterans in the study reportedan association between betrayal and decreasedquality of interpersonal relationships, as dem-onstrated through increases in blame and rejec-tion from others (McCormack & Joseph, 2014).Furthermore, veterans reported that their be-trayal in combat was expressed either internally(self-blaming) or externally (rage). The veteranswho experienced rage as a result of their be-trayal during combat reported heightened ag-gression since the betrayal and directed it to-ward those around them (McCormack &Joseph, 2014). Additionally, a more recentstudy of military personnel found that perceivedbetrayal was significantly associated with post-traumatic stress and anger (C. J. Bryan et al.,2016). C. J. Bryan and colleagues (2016) foundthat betrayal and perceived transgressionsagainst the self correlated most robustly withlife events in which the individual was victim toviolence, hostility, or another form of aggres-sion. Such findings demonstrate the connectionsbetween perceived betrayal and aggression andhighlight the need for further examination ofthis relationship. This study seeks to advancethe current literature by identifying the relation-ship between betrayal and interpersonal riskfactors for suicidal ideation (thwarted belong-ingness and perceived burdensomeness; Joiner,2005). Furthermore, we sought to examinewhether such associations would be moderatedby various forms of aggression, with the mag-nitude of the relationship increasing amongmore aggressive soldiers.

One way to conceptualize suicide risk is toexamine it from the perspective of the Interper-sonal-Psychological Theory of Suicide (IPTS;

2 MARTIN ET AL.

Thi

sdo

cum

ent

isco

pyri

ghte

dby

the

Am

eric

anPs

ycho

logi

cal

Ass

ocia

tion

oron

eof

itsal

lied

publ

ishe

rs.

Thi

sar

ticle

isin

tend

edso

lely

for

the

pers

onal

use

ofth

ein

divi

dual

user

and

isno

tto

bedi

ssem

inat

edbr

oadl

y.

Joiner, 2005). An important aspect of the IPTSis the emphasis on interpersonal relationshipsmeasured through the constructs of perceivedburdensomeness (PB) and thwarted belonging-ness (TB). PB refers to the belief that one is aburden to others and that one’s death is worthmore than one’s life. TB refers to the perceptionthat one lacks positive, reciprocal relationships(Joiner, 2005). Prior research among militarypersonnel has shown the importance of inter-personal relationships as protective factorsagainst suicide (C. J. Bryan, 2011; C. J. Bryan,Clemans, & Hernandez, 2012; C. J. Bryan, Mc-Naughton-Cassill, & Osman, 2013). Therefore,identifying the mechanisms by which interper-sonal relationships are disrupted for these indi-viduals is vital to understanding how suicidaldesire develops. Given previous research ontrust’s being an essential part of interpersonalrelationships, it appears plausible that betrayalwould be associated with elevated levels ofthwarted belongingness (Finkel, Rusbult, Ku-mashiro, & Hannon, 2002; Lewicki & Bunker,1996; Lewicki, McAllister, & Bies, 1998).

Previous research on betrayal has identifiednegative effects on interpersonal relationships(Finkel et al., 2002; Lewicki & Bunker, 1996;Lewicki et al., 1998). Although betrayal maypotentially lead to TB, clearly not all individu-als who are betrayed feel isolated. Given previ-ous findings linking betrayal to anger and ag-gression (Fehr & Baldwin, 1996; Finkel et al.,2002; Haden & Hojjat, 2006; Lewicki & Bun-ker, 1996; Mikula, Scherer, & Athenstaedt,1998), it appears plausible that some individualswho are betrayed respond aggressively or withincreased anger, thereby increasing the odds ofstrained relationships. In this sense, variousforms of aggression may represent importantmoderators in the association between betrayaland suicide risk factors such as TB. A commonway to measure aggression is through the Buss-Perry Aggression Questionnaire (BPAQ; Buss& Perry, 1992), which examines aggressionacross four different subscales: physical aggres-sion, verbal aggression, hostility, and anger.Each subscale includes questions on how indi-viduals react internally and externally when inan aggressive state. Physical and verbal aggres-sion assess individuals’ willingness to harmothers, anger assesses heightened arousal inpreparation for an altercation, and hostility as-

sesses an individual’s cognitive biases of injus-tice (Buss & Perry, 1992).

Previous aggression research within militarysamples has indicated a relationship betweenaggression and interpersonal distress. Studieshave shown that anger has been associated withnegative interpersonal outcomes and an in-crease in hostility (Taft, Schumm, Panuzio, &Proctor, 2008; Teten et al., 2010). A study uti-lizing a sample of National Guard and Reservemembers revealed that, among soldiers who haddeployment-related posttraumatic stress disor-der, 90.9% of men and 100% of women hadproblems with anger (Worthen et al., 2014).Moreover, another recent study has identified anassociation between stressful life events andsuicide risk among deployed Army NationalGuard personnel (Griffith, 2015). Here, re-searchers found that feelings of loneliness, anger,and/or frustration were associated with suiciderisk—but only when followed by interpersonalbehavior problems, including aggressive behaviortoward a significant other (Griffith, 2015).

We sought to build upon this literature baseby identifying the extent to which aggressionamplifies the association between betrayal andTB in a sample of previously deployed soldiersdrawn largely from the Army National Guard.We hypothesized that betrayal would be posi-tively associated with TB and that the fourfacets of the BPAQ—physical aggression, ver-bal aggression, hostility, and anger—wouldeach moderate this relationship, such that therelationship between betrayal and TB increasesin magnitude at higher levels of aggression.Given that TB and PB are typically highly cor-related with one another and both are proposedas necessary cognitive experiences for the de-velopment of serious suicidal ideation (Joiner,2005), we also wanted to examine the samemodel using PB as the outcome. The theoreticalrationale for aggression’s impacting the extentto which betrayal is associated with soldier’slater feeling like a burden on others and believ-ing his or her death is worth more than his or hercontinued life is less clear, however. As such,we did not put forth a priori hypotheses for thatset of analyses. If the results are consistent withour hypothesis, it may hold clinical significancefor military personnel returning from deploy-ment. Primarily, it would suggest a need tofocus clinical efforts on coping techniques forindividuals with heightened aggressive re-

3BETRAYAL AND BELONGING

Thi

sdo

cum

ent

isco

pyri

ghte

dby

the

Am

eric

anPs

ycho

logi

cal

Ass

ocia

tion

oron

eof

itsal

lied

publ

ishe

rs.

Thi

sar

ticle

isin

tend

edso

lely

for

the

pers

onal

use

ofth

ein

divi

dual

user

and

isno

tto

bedi

ssem

inat

edbr

oadl

y.

sponses, thereby potentially limiting the impactof betrayal on the development of broadly im-paired relationships and potential future suiciderisk. Furthermore, it may highlight the need formental health professionals to provide a forumin which to address perceived betrayals.

Method

Participants

Participants were U.S. military personnel(89.4% Army National Guard) drawn from alarger sample (N � 937) who presented ingroups of up to 25 at a large Joint ForcesTraining Center in the southern United States.Participants were eligible for the study if theywere affiliated with the U.S. military, were overthe age of 18, and could provide informed con-sent. The current study focused on a subsampleof military personnel who had experienced atleast one previous deployment (N � 5621;Mage � 28.67, SD � 8.19; 83.8% male). Thetwo most frequently endorsed times since mostrecent deployment were within the past month(57.5%) and more than three years ago (17.3%).The soldiers who had been deployed within thepast month were demobilizing from OperationEnduring Freedom at the time of the assess-ment. All other participants included in analysesidentified having one of the following: 1 to sixmonths since their last deployment (5.3%), 6months to 1 year since their last deployment(5.5%), between 1 and 2 years (6.6%), andbetween 2 and 3 years (7.8%). Participants inour sample primarily self-identified as White(66.7%), with African American (20.2%), His-panic or Latino/a (6.4%), Other (3.6%) Asian/Pacific Islander (1.8%), and Native American(1.3%) also being endorsed. Approximately half(50.5%) of the participants were never married,36.4% reported that they were currently in anactive marriage, 8.3% reported that they weredivorced, 4.2% were currently married but werenot in an active marriage (e.g., separated but notdivorced), and .5% were widowed. Addition-ally, a majority of participants were currentlyliving with one or more people (79.3%). Ap-proximately half of the sample reported thatthey had obtained some college-level education(50.1%). The remaining participants reportedobtaining a high school diploma or generalequivalency diploma (26.5%), or a college de-

gree (17.4%), a graduate school degree (3.8%),some graduate school (2.1%), or did not finishhigh school (.2%) as their highest level of edu-cation. Most participants were either employedfull-time (61.6%) or unemployed (25.8%). Fi-nally, participants reported that their family’sannual income ranged between $0-$10,000(4.7%), $10,001–$25,000 (14.4%), $25,001-50,000 (39.5%), $50,001-$75,000 (23%),$75,001-$100,000 (10.7%), and greater than$100,000 (7.7%).

Measures

Predictor and moderator.Moral Injury Events Scale (MIES; Nash et

al., 2013). The MIES is a nine-item measurethat identifies the extent to which participantshave observed, learned about, committed, orwere victims of acts that violated their moralbeliefs. A. O. Bryan and colleagues (2014)identified three distinct variables of the MIESon which we based our analyses. The threesubscales are Other-Transgressions (seeing orlearning about acts done by others that infringeon personal or moral beliefs), Self-Transgres-sions (acts completed by the individual thatinfringe on personal or moral beliefs), and Be-trayal (the perception that the individual hasbeen betrayed by others). Participants ratedtheir agreement with having experienced suchbetrayals and transgressions on a 6-point scaleranging from 1 (Strongly Agree) to 6 (StronglyDisagree). This measure has demonstrated goodinternal consistency as well as strong conver-gent and discriminant validity within militarysamples (A. O. Bryan et al., 2014, C. J. Bryan etal., 2016; Nash et al., 2013). The internal con-sistency of the Betrayal subscale in our samplewas .86. In the current study, all analyses wereperformed using the Betrayal subscale.

Buss Perry Aggression Questionnaire(BPAQ; Buss & Perry, 1992). The BPAQ is a29-item questionnaire that measures four differ-ent subscales of aggression: Physical Aggres-sion, Verbal Aggression, Hostility, and Anger.Physical Aggression is assessed by nine ques-tions related to participants’ tendency to engagein physical altercations. The Verbal Aggression

1 Analyses were run on the subsample of deployed per-sonnel. Due to missing data, our N varied between 219 and217. Specific numbers can be found in Tables 2 and 3.

4 MARTIN ET AL.

Thi

sdo

cum

ent

isco

pyri

ghte

dby

the

Am

eric

anPs

ycho

logi

cal

Ass

ocia

tion

oron

eof

itsal

lied

publ

ishe

rs.

Thi

sar

ticle

isin

tend

edso

lely

for

the

pers

onal

use

ofth

ein

divi

dual

user

and

isno

tto

bedi

ssem

inat

edbr

oadl

y.

subscale consists of five items that measureparticipants’ argumentative nature. The Hostil-ity subscale has eight items that assess cognitiveprocesses related to aggression. Finally, Angeris a seven-item subscale that assesses partici-pants’ temperament and control over their tem-perament. This self-report measure is scored ona 5-point scale ranging from 1 (Never or hardlyapplies to me) to 5 (Very often applies to me).Internal consistencies of the BPAQ for this sam-ple were as follows: Physical Aggression, .72;Verbal Aggression, .78; Hostility, .82; and An-ger, .74. This scale has demonstrated good re-liability when first measured and when retestedwith both civilian and military samples (Buss &Perry, 1992; Harris, 1997; Teten et al., 2010).

Outcome.Interpersonal Needs Questionnaire (INQ –

15; Van Orden, Cukrowicz, Witte, & Joiner,2012; Van Orden, Witte, Gordon, Bender, &Joiner, 2008). The INQ–15 measures levelsof TB and PB. The subscales of this measureconsist of nine items assessing TB and six itemsmeasuring PB. Each item is rated on a 7-pointscale ranging from 1 (Not at all true for me) to7 (Very true for me). Higher participant scoresindicate a higher level of either TB or PB. TheINQ–15 has demonstrated good construct valid-ity, reliability, and generalizability (Van Ordenet al., 2012). Previous research has tested theINQ–15 in military samples, and it has demon-strated good convergent validity and reliability(Gutierrez et al., 2016). The current study uti-lized TB as the outcome variable and PB as a

covariate in our primary analysis and reversedthe roles of those two variables in our explor-atory analysis. The internal consistency in thissample was .89 for the TB subscale and .91 forthe PB subscale.

Data Analytic Procedure

To test our hypothesis that the facets of theBPAQ would moderate the relationship betweenbetrayal and TB, we ran a series of four hierarchi-cal linear regressions using the PROCESS macrofor SPSS (Hayes, 2013). Significant interactionswere subsequently examined through analyses ofsimple slopes.

Results

Descriptive data for all variables used in anal-yses can be found in Table 1. A total of 28(5.0%) of the soldiers in this sample reportedcurrent suicidal ideation, and a total of 34(6.0%) reported a history of at least one lifetimesuicide attempt.

To develop our list of covariates, we exam-ined the associations between demographicvariables and our predictor (betrayal), modera-tors (physical aggression, verbal aggression,hostility, and anger), and outcome variable(thwarted belongingness). By controlling forvariables with significant associations with ourprimary variables of interest in each analysis,we aimed to conduct a stringent test of theproposed model while minimizing the impact

Table 1Descriptive Statistics and Correlations for Betrayal, Aggression, and Interpersonal Variables used in thePrimary Analyses

Variable 1 2 3 4 5 6 7

1. Betrayala —2. Physical aggressionb �.19�� —3. Verbal aggressionb �.24�� .63�� —4. Hostilityb �.26�� .55�� .60�� —5. Angerb �.20�� .67�� .64�� .68�� —6. Thwarted belongingness �.31�� .21�� .26�� .52�� .35�� —7. Perceived burdensomeness �.30�� .18�� .19�� .44�� .28�� .69�� —M 4.57 22.76 13.95 18.51 14.94 18.10 7.63SD 1.62 7.46 4.13 6.80 5.65 10.26 3.64Minimum 1.00 9.00 5.00 8.00 7.00 9.00 6.00Maximum 6.00 45.00 24.00 40.00 33.00 60.00 29.00

a Facets of moral injury. b Facet of aggression.�� p � .01.

5BETRAYAL AND BELONGING

Thi

sdo

cum

ent

isco

pyri

ghte

dby

the

Am

eric

anPs

ycho

logi

cal

Ass

ocia

tion

oron

eof

itsal

lied

publ

ishe

rs.

Thi

sar

ticle

isin

tend

edso

lely

for

the

pers

onal

use

ofth

ein

divi

dual

user

and

isno

tto

bedi

ssem

inat

edbr

oadl

y.

on statistical power. In this sense, variableswere included as covariates in specific analysesonly if the results described in the followingparagraphs indicated that they exhibited a sig-nificant association with one or more of theprimarily variables of interest in that specificanalysis.

Continuous demographic variables were in-vestigated using zero-order correlations. Exam-ination of these variables revealed that age wassignificantly associated with all moderators(physical aggression, r � �.24, p � .001; ver-bal aggression, r � �.15, p � .001; hostility,r � �.15, p � .001; anger, r � �.15, p �.001), indicating that older age is associatedwith less aggression. Furthermore, socioeco-nomic status (SES) was significantly associatedwith TB (r � �.13, p � .004), such that greaterSES levels were associated with less severescores on TB. Last, level of education was sig-nificantly associated with physical aggression(r � �.20, p � .001), hostility (r � �.11, p �.02), and anger (r � �.11, p � .02), such thatgreater education was associated with less ag-gression.

Dichotomous demographic variables were in-vestigated using analyses of variance. Examina-tion of these variables revealed that there weresignificant between-groups differences by sexon levels of physical aggression, F(1, 449) �13.88, p � .001, with men displaying highermean levels of physical aggression than didwomen. There were also significant between-groups differences by race on thwarted belong-ingness, F(5, 468) � 2.37, p � .04. Althoughthis omnibus test was significant, post hoc anal-yses did not reveal significant differences be-tween any two races. Furthermore, there weresignificant between-groups differences by mar-ital status on thwarted belongingness, F(4,467) � 5.33, p � .001, with those who werewidowed and not remarried reporting signifi-cantly higher mean levels of thwarted belong-ingness than did those who had never beenmarried, those who were currently married, andthose who were currently separated from theirspouse. Additionally, there were significant be-tween-groups differences by employment onbetrayal, F(2, 346) � 3.49, p � .03, with indi-viduals employed part-time endorsing signifi-cantly higher mean levels of betrayal relative toindividuals employed full-time. Perceived bur-densomeness, the other component of suicidal

desire as conceptualized by the interpersonal–psychological theory of suicide (Joiner, 2005),was also included as a covariate in all analyses.This was done to determine whether the inter-action of betrayal and aggression predictthwarted belongingness specifically, as opposedto suicidal desire more broadly. This approachhas been utilized increasingly often in studiesexamining the IPTS (Forrest et al., 2016; Hill &Pettit, 2012; Moberg & Anestis, 2015) and hasbeen proposed as a method of improving under-standing of the extent to which specific vari-ables exhibit differential relationships with TBand PB, thereby highlighting the need to con-sider those variables in isolation from one an-other. Additionally, the other facets of aggres-sion characterized in the BPAQ were includedas covariates in all analyses to determine theunique impact of each type of aggression on therelationship between betrayal and thwarted be-longingness.

Primary Analyses

Results indicated that the interaction of be-trayal and physical aggression significantly pre-dicted thwarted belongingness, t(216) � �2.54,p � .012, f2 � .03. Analyses of simple slopesfurther revealed that betrayal was associatedwith thwarted belongingness at high, t(216) ��3.38, p � .001, but not mean, t(216) � �1.89, p � .061, or low, t(216) � .25, p � .806,levels of physical aggression. Furthermore, re-sults indicated that the interaction of betrayaland verbal aggression significantly predictedthwarted belongingness, t(218) � �2.21, p �.028, f2 � .03. Examination of analyses ofsimple slopes revealed that betrayal was asso-ciated with thwarted belongingness at high,t(218) � �3.02, p � .003, but not mean,t(218) � �1.66, p � .098, or low, t(218) � .15,p � .879, levels of verbal aggression. Theseresults are presented in Table 2 and Figure 1.

Results also showed that the interaction ofbetrayal and hostility significantly predictedthwarted belongingness, t(218) � �2.36, p �.019, f2 � .03. Simple slopes analyses furtherrevealed that betrayal was associated withthwarted belongingness at high, t(218) � �3.12, p � .002, but not mean, t(218) � �1.80,p � .074, or low, t(218) � .18, p � .858, levels

6 MARTIN ET AL.

Thi

sdo

cum

ent

isco

pyri

ghte

dby

the

Am

eric

anPs

ycho

logi

cal

Ass

ocia

tion

oron

eof

itsal

lied

publ

ishe

rs.

Thi

sar

ticle

isin

tend

edso

lely

for

the

pers

onal

use

ofth

ein

divi

dual

user

and

isno

tto

bedi

ssem

inat

edbr

oadl

y.

of hostility. Finally, results indicated that theinteraction of betrayal and anger significantlypredicted thwarted belongingness, t(218) � �3.13, p � .002, f2 � .05. Simple slopes analyses

further indicated that betrayal was associatedwith thwarted belongingness at high, t(218) ��3.56, p � .001, but not mean, t(218) � �1.69,p � .092, or low, t(218) � .67, p � .505, levels

Table 2Physical Aggression and Verbal Aggression as Moderators of the Relationship Between Betrayal andThwarted Belongingness

N � 217 N � 219

Variable R2 �R2 b SE p R2 �R2 b SE p

Model summary .555 .544Age �.05 .08 .553 �.04 .07 .624SES �.25 .47 .598 �.33 .439 .450Race .38 .45 .399 .29 .44 .510Marital status �.19 .59 .744 �.37 .59 .529Employment status 1.27 .63 .044 1.32 .62 .036Education �.02 .61 .979Sex .02 1.34 .990Verbal aggression �.21 .17 .205 .47 .36 .193Hostility .45 .11 .000 .45 .11 .000Anger .06 .13 .674 .07 .13 .609Perceived burdensomeness 8.19 .85 .000 7.99 .85 .000Physical aggression .40 .20 .050 �.04 .09 .672Betrayal 1.64 1.01 .106 1.65 1.11 .140

Interaction .569 .014 .555 .011Betrayal � Physical Aggression �.10 .04 .012Betrayal � Verbal Aggression �.15 .07 .028

Note. SES � socioeconomic status.

Figure 1. Physical and verbal aggression moderating the association between betrayal andthwarted belongingness as indicators of the potential for suicide among U.S. military per-sonnel.

7BETRAYAL AND BELONGING

Thi

sdo

cum

ent

isco

pyri

ghte

dby

the

Am

eric

anPs

ycho

logi

cal

Ass

ocia

tion

oron

eof

itsal

lied

publ

ishe

rs.

Thi

sar

ticle

isin

tend

edso

lely

for

the

pers

onal

use

ofth

ein

divi

dual

user

and

isno

tto

bedi

ssem

inat

edbr

oadl

y.

of anger. These results are presented in Table 3and Figure 2.2

Exploratory Analyses

Given the conceptual overlap between TBand PB and their proposed combined role in thedevelopment of suicidal ideation (Joiner, 2005),we also reran our moderation analyses with PBrather than TB serving as the outcome variable.In each case, the interaction between aggression(physical aggression, verbal aggression, anger,hostility) and betrayal was nonsignificant (ps �.12). The main effect of betrayal was significantin three of the four analyses (physical aggres-sion, hostility, anger: �s � .11, ps � .032). Themain effect was nonsignificant in the verbalaggression moderation equation. This is likelyexplained by the fact that the covariate list wasslightly different (education level was not asso-ciated with verbal aggression and, as such, wasnot included in that analysis). None of the ag-gression subscales exhibited a significant maineffect on PB.

Discussion

The present study sought to examine the re-lationship between betrayal and TB in a largesample of previously deployed soldiers drawnlargely from the Army National Guard, the mil-itary component with the highest suicide rate.This study further sought to examine whethervarious aspects of aggression impacted thestrength of this relationship. Consistent with ourhypotheses, each facet of aggression identifiedin the BPAQ (physical aggression, verbal ag-gression, hostility, and anger) significantlymoderated the relationship between betrayaland TB, such that betrayal was associated withTB at high but not mean or low levels of ag-gression. These preliminary findings indicatethat military personnel who have experiencedbetrayal during deployment may be particularlyvulnerable to developing severely impaired re-lationships (TB) if they tend to exhibit an ag-gressive response pattern. Given that TB is a riskfactor for the development of suicidal ideation,these findings represent preliminary evidence thatthe path from difficult deployment experiences tothe eventual development of suicide risk (e.g.,ideation) may be heavily influenced by trait re-

sponse patterns such as aggression, thereby high-lighting vital treatment and prevention targets.

Experiencing betrayal can be isolating formany reasons. When an individual loses trust inthose around them, the person may begin to feellonely and withdrawn from others and/or ex-press outward resentment. Past studies havefound that betrayal can result in reassessment ofrelationships, regret, sadness, anger, and loss ofself-esteem (e.g., Fehr & Baldwin, 1996; Finkelet al., 2002), indicating that such an experiencemay impact perceptions of connectedness withothers. This may be especially true for militarypersonnel, who are trained to depend on fellowsoldiers and who develop strong connections tothese individuals. Experiencing betrayal at thehands of such trusted comrades could cause anindividual to question military bonds, whichmay result in increased TB. This point may beparticularly amplified in the National Guard be-cause soldiers in this component of the militaryalternate between civilian and military life-styles, thereby diminishing the extent to whichthey can fully integrate into either world. Ag-gression could also be a foundation for de-creased quality of interpersonal relationships.Individuals who score high on the BPAQ an-swered questions relating to their interactionswith others such as “Once in a while I can’tcontrol the urge to strike another person” and “Ioften find myself disagreeing with people”;Buss & Perry, 1992, p. 454). These negativeinteractions could contribute to a lack of posi-tive interpersonal relationships, and once theseindividuals feel as though they have been be-trayed, these negative reactions and resentmentscould manifest and influence other relation-ships. Our results are consistent with those ofprevious research in which higher scores on anaggression questionnaire were associated withdecreased quality of interpersonal relationships(Taft et al., 2008; Teten et al., 2010).

Our exploratory analyses examining this samemodel in the prediction of PB produced a differentprofile of results. In these analyses, none of theinteraction terms were significant, indicating thataggression does not influence any association be-

2 In order to ensure that our demographic covariates didnot spuriously influence the results, we reran our analyseswithout demographic covariates. Results were unchangedwith respect to statistical significance and the nature of theconditional effects.

8 MARTIN ET AL.

Thi

sdo

cum

ent

isco

pyri

ghte

dby

the

Am

eric

anPs

ycho

logi

cal

Ass

ocia

tion

oron

eof

itsal

lied

publ

ishe

rs.

Thi

sar

ticle

isin

tend

edso

lely

for

the

pers

onal

use

ofth

ein

divi

dual

user

and

isno

tto

bedi

ssem

inat

edbr

oadl

y.

tween betrayal and feelings of burdensomeness.There was a modest main effect of betrayal on PBin three of the four analyses, which representspreliminary evidence that feeling betrayed by oth-ers during deployment may result in soldiers’ later

developing a sense that their death is worth moreto others than their continued life. Given our lackof a priori hypotheses for these analyses and theircross-sectional nature, however, further replica-tion in alternate study designs is needed before

Table 3Hostility and Anger as Moderators of the Relationship Between Betrayal and Thwarted Belongingness

N � 219 N � 219

Variable R2 �R2 b SE p R2 �R2 b SE p

Model summary .545 .554Age �.05 .08 .535 �.06 .07 .462SES �.27 .46 .554 �.43 .46 .347Race .24 .44 .590 .23 .43 .593Marital status �.29 .59 .621 �.31 .58 .597Employment status 1.20 .63 .056 1.35 .62 .031Education .06 .60 .926 .20 .60 .745Physical �.05 .09 .587 �.04 .09 .660Verbal �.23 .17 .171 �.26 .17 .118Anger .12 .13 .366 .73 .24 .003Perceived burdensomeness 7.64 .87 .000 7.96 .85 .000Hostility .89 .22 .000 .46 .11 .000Betrayal 1.27 .90 .160 1.70 .83 .043

Interaction .557 .012 .575 .021Betrayal � Hostility �.10 .04 .019Betrayal � Anger �.15 .05 .002

Note. SES � socioeconomic status.

Figure 2. Anger and hostility moderating the association between betrayal and thwartedbelongingness as indicators of the potential for suicide among U.S. military personnel.

9BETRAYAL AND BELONGING

Thi

sdo

cum

ent

isco

pyri

ghte

dby

the

Am

eric

anPs

ycho

logi

cal

Ass

ocia

tion

oron

eof

itsal

lied

publ

ishe

rs.

Thi

sar

ticle

isin

tend

edso

lely

for

the

pers

onal

use

ofth

ein

divi

dual

user

and

isno

tto

bedi

ssem

inat

edbr

oadl

y.

any firm conclusions can be developed regardingthose relationships.

An examination of our covariates yielded somesignificant results. For the interaction of physicalaggression moderating the relationship betweenbetrayal and TB, hostility was significantly asso-ciated with TB (p � .000). When verbal aggres-sion moderated the relationship, employment (p �.036) and hostility (p � .000) were significantlyassociated with TB. When hostility moderated,PB was a significant covariate (p � .000). Finally,when anger moderated, employment (p � .031),hostility (p � .000), and PB (p � .000) were allsignificant. Should this pattern replicate in futureexaminations of this model, this may indicate thatsuch variables are important clinical targets inreducing vulnerability to TB; however, given thevariability in significant covariates across analysesand our lack of a priori predictions for those vari-ables, we are hesitant to express any pronouncedbeliefs on their meaning.

In the current study, we chose to limit ourinvestigation to the associations between be-trayal and TB because we felt it was the clearestmodel that fit best with prior literature. How-ever, future studies should examine the possi-bility that important relationships may exist be-tween the current variables under investigation,as well as the other two aspects of the MoralInjury Events Scale (self-transgressions andother-transgressions) and perceived burden-someness. Future studies should investigatethese relationships to understand how moralinjury and suicidal desire interact more broadly.

Although we believe these results provide im-portant information in understanding suicide riskwithin the National Guard, we also note that thisstudy had several limitations. First, the informa-tion for this study was gathered through electronicself-report surveys. Similar to the case in anyself-report survey, the data collected may not ac-curately portray the participants’ beliefs or expe-riences. This limitation is especially noteworthywithin military populations because military per-sonnel tend to underreport or modify reporting ofspecific symptoms, such as suicidal thoughts(Blocker & Miller, 2013; Hoge & Castro, 2012;Rudd, 2013). Another limitation to this study isthat the data were cross-sectional in nature, whichprevents us from drawing causal inferences aboutthe relationship between betrayal, aggression, andTB. These preliminary findings should be repli-cated assessing soldiers’ aggression and feelings

of betrayal pre- and postdeployment. Doing sowill allow increased confidence in the proposeddirectionality of the effects in our model. Addi-tionally, we assessed for SES and not rank. Usinga military sample, rank could provide insight intowork-related stressors and responsibilities. Fur-thermore, a limitation is the use of the INQ–15instead of other psychometrically establishedmeasures for TB and PB. Finally, because thesample consisted of primarily National Guard sol-diers, we cannot generalize these findings to othercomponents of the military. In particular, the ex-tent to which these results would apply to activeduty military who live on base between deploy-ments should be specifically investigated in thefuture. Future work should consider examining towhat extent our model directly predicts suicidalideation. Given the low level of current ideation inour sample, we were unable to address that com-ponent of the model.

Despite the aforementioned limitations, thisstudy has important strengths. First, the largesample size lent statistical strength to the study.The sample itself comprised military personnel,primarily drawn from the Army NationalGuard. This is particularly important becausethe National Guard is an understudied popula-tion at increased risk for suicide. Finally, thisstudy is one of the first to investigate the impactof perceived betrayal on suicide risk. The re-sults indicate that experiencing betrayal may leadto TB, particularly when the betrayed individualalso has high levels of aggression. This studyidentifies that a unique deployment-related expe-rience, betrayal, can influence suicide risk amongpreviously deployed military personnel. There-fore, identifying soldiers who have had betrayalexperiences may aid risk assessment and also pro-vide clinicians with a target for treatment. Further-more, these findings indicate a need for interven-tions that address aggression among militarypersonnel. Such interventions would be especiallyuseful for individuals who have experiencedmoral injury during combat.

References

Blocker, G. M., & Miller, J. A. (2013). Unintendedconsequences: Stigma and suicide prevention ef-forts. Military Medicine, 178, 473. http://dx.doi.org/10.7205/MILMED-D-13-00056

Bryan, C. J. (2011). The clinical utility of a briefmeasure of perceived burdensomeness and

10 MARTIN ET AL.

Thi

sdo

cum

ent

isco

pyri

ghte

dby

the

Am

eric

anPs

ycho

logi

cal

Ass

ocia

tion

oron

eof

itsal

lied

publ

ishe

rs.

Thi

sar

ticle

isin

tend

edso

lely

for

the

pers

onal

use

ofth

ein

divi

dual

user

and

isno

tto

bedi

ssem

inat

edbr

oadl

y.

thwarted belongingness for the detection of sui-cidal military personnel. Journal of Clinical Psy-chology, 67, 981–992. http://dx.doi.org/10.1002/jclp.20726

Bryan, C. J. (2015). Adjusting our aim: next steps inmilitary and veteran suicide prevention. Spiritual-ity in Clinical Practice, 2, 84–85.

Bryan, C. J., Bryan, A. O., Anestis, M. D., Anestis,J. C., Green, B. A., Etienne, N., . . . Ray-Sannerud,B. (2016). Measuring moral injury: Psychometricproperties of the Moral Injury Events Scale in twomilitary samples. Assessment, 23, 557–570. http://dx.doi.org/10.1177/1073191115590855

Bryan, A. O., Bryan, C. J., Morrow, C. E., Etienne,N., & Ray-Sannerud, B. (2014). Moral Injury, Sui-cidal Ideation, and Suicide Attempts in a MilitarySample. Traumatology, 20, 154–160.

Bryan, C. J., Clemans, T. A., & Hernandez, A. M.(2012). Perceived burdensomeness, fearlessness ofdeath, and suicidality among deployed militarypersonnel. Personality and Individual Differences,52, 374 –379. http://dx.doi.org/10.1016/j.paid.2011.10.045

Bryan, C. J., McNaughton-Cassill, M., & Osman, A.(2013). Age and belongingness moderate the ef-fects of combat exposure on suicidal ideationamong active duty Air Force personnel. Journal ofAffective Disorders, 150, 1226–1229. http://dx.doi.org/10.1016/j.jad.2013.05.087

Buss, A. H., & Perry, M. (1992). The AggressionQuestionnaire. Journal of Personality and SocialPsychology, 63, 452– 459. http://dx.doi.org/10.1037/0022-3514.63.3.452

Centers for Disease Control and Prevention. (2013).Web- Based Injury Statistics and Query and Re-porting System (WISQARS). Available at https://www.cdc.gov/injury/wisqars/index.html. Ac-cessed September 25, 2015.

Doka, K. J. (2002). Disenfranchised grief: New di-rection, challenges, and strategies for practice.Ann Arbor, MI: Malloy Lithographing.

Fehr, B., & Baldwin, M. (1996). Prototype and scriptanalyses of laypeople’s knowledge of anger. InG. J. O. Fletcher & J. Fitness (Eds.), Knowledgestructures in close relationships: A social psycho-logical approach (pp. 219–245). Hillsdale, NJ:Erlbaum.

Fiala, A. (2008). The just war myth. New York, NY:Rowman & Littlefield.

Finkel, E. J., Rusbult, C. E., Kumashiro, M., & Han-non, P. A. (2002). Dealing with betrayal in closerelationships: Does commitment promote forgive-ness? Journal of Personality and Social Psychol-ogy, 82, 956–974. http://dx.doi.org/10.1037/0022-3514.82.6.956

Forrest, L. N., Bodell, L. P., Witte, T. K., Goodwin,N., Bartlett, M. L., Siegfried, N., . . . Smith, A. R.(2016). Associations between eating disorder

symptoms and suicidal ideation through thwartedbelongingness and perceived burdensomenessamong eating disorder patients. Journal of Affec-tive Disorders, 195, 127–135. http://dx.doi.org/10.1016/j.jad.2016.02.017

Griffith, J. (2012a). Correlates of suicide amongArmy National Guard soldiers. Military Psychol-ogy, 24, 568 –591. http://dx.doi.org/10.1080/08995605.2012.736324

Griffith, J. (2012b). Suicide in the Army NationalGuard: An empirical inquiry. Suicide and Life-Threatening Behavior, 42, 104–119. http://dx.doi.org/10.1111/j.1943-278X.2011.00075.x

Griffith, J. (2015). Suicide in the U.S. Army: Stres-sor-strain hypothesis among deployed and nonde-ployed Army National Guard soldiers. Journal ofAggression, Conflict and Peace Research, 7, 187–198. http://dx.doi.org/10.1108/JACPR-05-2014-0125

Gutierrez, P. M., Pease, J., Matarazzo, B. B., Mon-teith, L. L., Hernandez, T., & Osman, A. (2016).Evaluating the psychometric properties of the In-terpersonal Needs Questionnaire and the AcquiredCapability for Suicide Scale in military veterans.Psychological Assessment, 28, 1684–1694. http://dx.doi.org/10.1037/pas0000310

Haden, S. C., & Hojjat, M. (2006). Aggressive re-sponses to betrayal: Type of relationship, victim’ssex, and nature of aggression. Journal of Socialand Personal Relationships, 23, 101–116. http://dx.doi.org/10.1177/0265407506060181

Harris, J. A. (1997). A further evaluation of theAggression Questionnaire: Issues of validity andreliability. Behaviour Research and Therapy, 35,1047–1053. http://dx.doi.org/10.1016/S0005-7967(97)00064-8

Harvey, J. H. (2002). Perspectives of loss and trau-ma: Assaults on the self. http://dx.doi.org/10.4135/9781483328638

Hayes, A. F. (2013). Introduction to mediation, mod-eration, and conditional process analysis: A re-gression-based approach. New York, NY: Guil-ford Press.

Hill, R. M., & Pettit, J. W. (2012). Suicidal ideationand sexual orientation in college students: Theroles of perceived burdensomeness, thwarted be-longingness, and perceived rejection due to sexualorientation. Suicide and Life-Threatening Behav-ior, 42, 567–579. http://dx.doi.org/10.1111/j.1943-278X.2012.00113.x

Hoge, C. W., & Castro, C. A. (2012). Preventingsuicides in US service members and veterans:Concerns after a decade of war. Journal of theAmerican Medical Association, 308, 671– 672.http://dx.doi.org/10.1001/jama.2012.9955

Joiner, T. E. (2005). Why people die by suicide.Boston, MA: Harvard University Press.

Kauffmann, G. (2002). Safety and the assumptive

11BETRAYAL AND BELONGING

Thi

sdo

cum

ent

isco

pyri

ghte

dby

the

Am

eric

anPs

ycho

logi

cal

Ass

ocia

tion

oron

eof

itsal

lied

publ

ishe

rs.

Thi

sar

ticle

isin

tend

edso

lely

for

the

pers

onal

use

ofth

ein

divi

dual

user

and

isno

tto

bedi

ssem

inat

edbr

oadl

y.

world: A theory of traumatic loss. In J. Kauffman(Ed.), Loss of the assumptive world: A theory oftraumatic loss (pp. 205–211). New York, NY:Brunner-Routledge.

Kline, A., Ciccone, D. S., Falca-Dodson, M., Black,C. M., & Losonczy, M. (2011). Suicidal ideationamong National Guard troops deployed to Iraq:The association with postdeployment readjustmentproblems. Journal of Nervous and Mental Disease,199, 914 –920. http://dx.doi.org/10.1097/NMD.0b013e3182392917

Lewicki, R. J., & Bunker, B. B. (1996). Developingand maintaining trust in work relationships. InR. M. Kramer & T. R. Tyler (Eds.), Trust inorganizations: Frontiers of theory and research(pp. 114 –139). http://dx.doi.org/10.4135/9781452243610.n7

Lewicki, R. J., McAllister, D. J., & Bies, R. J. (1998).Trust and distrust: New relationships and realities.Academy of Management Review, 23, 438–458.

Litz, B. T., Stein, N., Delaney, E., Lebowitz, L.,Nash, W. P., Silva, C., & Maguen, S. (2009).Moral injury and moral repair in war veterans: Apreliminary model and intervention strategy. Clin-ical Psychology Review, 29, 695–706. http://dx.doi.org/10.1016/j.cpr.2009.07.003

McCormack, L., & Joseph, S. (2014). Psychologicalgrowth in aging Vietnam veterans: Redefiningshame and betrayal. Journal of Humanistic Psy-chology, 54, 336–355. http://dx.doi.org/10.1177/0022167813501393

Mikula, G., Scherer, K., & Athenstaedt, U. (1998).The role of injustice in the elicitation of differen-tial emotional reactions. Personality and SocialPsychology Bulletin, 24, 769–783. http://dx.doi.org/10.1177/0146167298247009

Moberg, F. B., & Anestis, M. D. (2015). A prelimi-nary examination of the relationship between so-cial networking interactions, Internet use, andthwarted belongingness. Crisis: The Journal ofCrisis Intervention and Suicide Prevention, 36,187–193. http://dx.doi.org/10.1027/0227-5910/a000311

Nash, W. P., Marino Carper, T. L., Mills, M. A., Au,T., Goldsmith, A., & Litz, B. T. (2013). Psycho-metric evaluation of the Moral Injury Events Scale.Military Medicine, 178, 646–652. http://dx.doi.org/10.7205/MILMED-D-13-00017

National Center for Telehealth and Technology,Defense Centers for Psychological Health.(2014). Department of Defense suicide event re-

port (DoDSER): Calendar year 2013 report. JointBase Lewis-McChord, WA: Author.

Nock, M. K., Deming, C. A., Fullerton, C. S., Gil-man, S. E., Goldenberg, M., Kessler, R. C., . . .Ursano, R. J. (2013). Suicide among soldiers: Areview of psychosocial risk and protective factors.Psychiatry: Interpersonal and Biological Pro-cesses, 76, 97–125. http://dx.doi.org/10.1521/psyc.2013.76.2.97

Rudd, M. D. (2013). Suicide in the military. In B. A.Moore & J. E. Barnett (Eds.), Military psycholo-gists’ desk reference (pp. 143–147). http://dx.doi.org/10.1093/med:psych/9780199928262.003.0029

Shay, J. (1994). Achilles in Vietnam. Combat traumaand the undoing of character. New York, NY:Scribner.

Taft, C. T., Schumm, J. A., Panuzio, J., & Proctor,S. P. (2008). An examination of family adjustmentamong Operation Desert Storm veterans. Journalof Consulting and Clinical Psychology, 76, 648–656. http://dx.doi.org/10.1037/a0012576

Teten, A. L., Miller, L. A., Stanford, M. S., Petersen,N. J., Bailey, S. D., Collins, R. L., . . . Kent, T. A.(2010). Characterizing aggression and its associa-tion to anger and hostility among male veteranswith post-traumatic stress disorder. Military Med-icine, 175, 405– 410. http://dx.doi.org/10.7205/MILMED-D-09-00215

Van Orden, K. A., Cukrowicz, K. C., Witte, T. K., &Joiner, T. E. (2012). Thwarted belongingness andperceived burdensomeness: Construct validity andpsychometric properties of the Interpersonal NeedsQuestionnaire. Psychological Assessment, 24,197–215. http://dx.doi.org/10.1037/a0025358

Van Orden, K. A., Witte, T. K., Gordon, K. H.,Bender, T. W., & Joiner, T. E., Jr. (2008). Suicidaldesire and the capability for suicide: Tests of theinterpersonal-psychological theory of suicidal be-havior among adults. Journal of Consulting andClinical Psychology, 76, 72–83. http://dx.doi.org/10.1037/0022-006X.76.1.72

Worthen, M., Rathod, S. D., Cohen, G., Sampson, L.,Ursano, R., Gifford, R., . . . Ahern, J. (2014).Anger problems and posttraumatic stress disorderin male and female National Guard and ReserveService members. Journal of Psychiatric Re-search, 55, 52–58. http://dx.doi.org/10.1016/j.jpsychires.2014.04.004

Received October 27, 2015Revision received December 2, 2016

Accepted December 13, 2016 �

12 MARTIN ET AL.

Thi

sdo

cum

ent

isco

pyri

ghte

dby

the

Am

eric

anPs

ycho

logi

cal

Ass

ocia

tion

oron

eof

itsal

lied

publ

ishe

rs.

Thi

sar

ticle

isin

tend

edso

lely

for

the

pers

onal

use

ofth

ein

divi

dual

user

and

isno

tto

bedi

ssem

inat

edbr

oadl

y.

View publication statsView publication stats