, Volume 10, Issue 12, pp 2544–2554 | Cite as

Self-Compassion and Suicide Risk in Veterans: When the Going Gets Tough, Do the Tough Benefit More from Self-Compassion?

  • Jessica Kelliher Rabon
  • Jameson K. HirschEmail author
  • Andrea R. Kaniuka
  • Fuschia Sirois
  • Byron D. Brooks
  • Kristin Neff



Veterans are at particular risk for suicide due to psychopathological, emotional, and interpersonal risk factors. However, the presence of individual-level protective factors, such as self-compassion, may reduce risk, becoming more salient at increasing levels of distress and psychopathology, per theory. We examined the relation between self-compassion and suicide risk, and the moderating effects of depression, PTSD symptoms, anger, shame, and thwarted interpersonal needs.


Our sample of US veterans (n = 541) in our cross-sectional study were mostly male (69.1%) with an average age of 49.90 (SD = 16.78), who completed online self-report measures: Suicidal Behaviors Questionnaire-Revised, Multidimensional Health Profile-Psychosocial Functioning Screening Tool, PTSD Checklist-Military Version, Differential Emotions Scale-IV, and the Interpersonal Needs Questionnaire.


The linkage between self-compassion and suicidal behavior in our veteran sample was moderated by distress-evoking risk factors, including depression, anger, shame, and thwarted interpersonal needs, such that, as level of risk severity increases, the inverse association between self-compassion and suicidal behavior is strengthened.


Our findings highlight an emergent protective process that may prevent suicide in times of distress. Therapeutically bolstering the ability for self-compassion may provide a proactive coping strategy that can be brought to bear in times of crisis, reducing suicide risk for veterans.


Self-Compassion Suicide Veterans Depression Anger Shame 


Author Contributions

JR conducted data analyses for the research and was the primary author. JH designed and executed the study, collaborated in analyses, and contributed to the writing of the manuscript. AK collaborated in analyses and writing of the manuscript. FS consulted on the design of the study and collaborated in analyses and writing of the manuscript. BB collaborated in analyses and writing of the manuscript. KN consulted on the study design and analyses and contributed to the writing of the manuscript.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the IRB of East Tennessee State University 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 the study.


  1. Allen, A. B., & Leary, M. R. (2010). Self-compassion, stress, and coping. Social and Personality Psychology Compass, 4(2), 107–118. Scholar
  2. American Association of Suicidology [AAS]. (2014). U.S.A. suicide: 2014 official final data. Retrieved from:
  3. American Psychiatric Association [APA]. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.CrossRefGoogle Scholar
  4. Arimitsu, K., & Hofmann, S. G. (2015). Cognitions as mediators in the relationship between self-compassion and affect. Personality and Individual Differences, 74, 41–48. Scholar
  5. Beautrais, A. L. (2001). Suicides and serious suicide attempts: two populations or one? Psychological Medicine, 31(5), 837–845. Scholar
  6. Benjamin, A. J., Jr., Kepes, S., & Bushman, B. J. (2018). Effects of weapons on aggressive thoughts, angry feelings, hostile appraisals, and aggressive behavior: a meta-analytic review of the weapons effect literature. Personality and Social Psychology Review, 22(4), 347–377. Scholar
  7. Boersma, K., Håkanson, A., Salomonsson, E., & Johansson, I. (2015). Compassion focused therapy to counteract shame, self-criticism and isolation. A replicated single case experimental study for individuals with social anxiety. Journal of Contemporary Psychotherapy, 45(2), 89–98. Scholar
  8. Bryan, C. J., Morrow, C. E., Anestis, M. D., & Joiner, T. E. (2010). A preliminary test of the interpersonal-psychological theory of suicidal behavior in a military sample. Personality and Individual Differences, 48, 347–350. Scholar
  9. Bryan, C. J., Clemans, T. A., Hernandez, A. M., & Rudd, M. D. (2013a). Loss of consciousness, depression, posttraumatic stress disorder, and suicide risk among deployed military personnel with mild traumatic brain injury (mTBI). The Journal of Head Trauma Rehabilitation, 28, 13–20. Scholar
  10. Bryan, C. J., Hernandez, A. M., Allison, S., & Clemans, T. (2013b). Combat exposure and suicide risk in two samples of military personnel. Journal of Clinical Psychology, 69, 64–77. Scholar
  11. Bryan, C. J., Morrow, C. E., Etienne, N., & Ray-Sannerud, B. (2013c). Guilt, shame, and suicidal ideation in a military outpatient clinical sample. Depression and Anxiety, 30, 55–60. Scholar
  12. Bryan, C. J., Graham, E., & Roberge, E. (2015a). Living a life worth living: spirituality and suicide risk in military personnel. Spirituality in Clinical Practice, 2, 74–78. Scholar
  13. Bryan, C. J., Roberge, E., Bryan, A. O., Ray-Sannerud, B., Morrow, C. E., & Etienne, N. (2015b). Guilt as a mediator of the relationship between depression and posttraumatic stress with suicide ideation in two samples of military personnel and veterans. International Journal of Cognitive Therapy, 8, 143–155. Scholar
  14. Center for Disease Control [CDC]. (2015). Suicide facts at a glance 2015. Retrieved from:
  15. Conner, K. R., McCarthy, M. D., Bajorska, A., Caine, E. D., Tu, X. M., & Knox, K. L. (2012). Mood, anxiety, and substance-use disorders and suicide risk in a military population cohort. Suicide & Life-Threatening Behavior, 42(6), 699–708. Scholar
  16. Currier, J. M., Holland, J. M., Drescher, K., & Foy, D. (2015). Initial psychometric evaluation of the Moral Injury Questionnaire. Clinical Psychology & Psychotherapy, 22(1), 54–63. Scholar
  17. Dahm, K. A., Meyer, E. C., Neff, K. D., Kimbrel, N. A., Bulliver, S. B., & Morisette, S. B. (2015). Mindfulness, self-compassion, posttraumatic stress disorder symptoms, and functional disability in U.S. Iraq and Afghanistan war veterans. Journal of Traumatic Stress, 28(5), 460–464. Scholar
  18. Department of Defense. (2010). The challenge and the promise: strengthening the force, preventing suicide, and saving lives. Final Report of the Department of Defense Task Force on the Prevention of Suicide by Members of the Armed Forces.Google Scholar
  19. Dunne, S., Sheffield, D., & Chilcot, J. (2016). Brief report: self-compassion, physical health and the mediating role of health-promoting behaviours. Journal of Health Psychology, 1–7. Scholar
  20. Eaton, K. M., Messer, S. C., Wilson, A. G., & Hoge, C. W. (2006). Strengthening the validity of population-based suicide rate comparisons: an illustration using U.S. military and civilian data. Suicide and Life-threatening Behavior, 36(2), 182–191. Scholar
  21. Fanning, J. R., & Pietrzak, R. H. (2013). Suicidality among older male veterans in the United States: results from the National Health and Resilience in Veterans study. Journal of Psychiatric Research, 47(11), 1766–1775. Scholar
  22. Gibbons, R. D., Hendricks, B. C., & Hur, K. (2012). Is the rate of suicide among veterans elevated? American Journal of Public Health Supplement 1, 102(S1), S17–S19. Scholar
  23. Gilbert, P. (2005). Compassion and cruelty: a biopsychosocial approach. In P. Gilbert (Ed.), Compassion: Conceptualisations, research and use in psychotherapy (pp. 9–74). London: Routledge.Google Scholar
  24. Hasking, P., Boyes, M. E., Finlay-Jones, A., McEvoy, P. M., & Rees, C. S. (2018). Common pathways to NSSI and suicide ideation: the roles of rumination and self-compassion. Archives of Suicide Research. Scholar
  25. Hawkins, K. A., & Cougle, J. R. (2013). A test of the unique and interactive roles of anger experience and expression in suicidality: findings from a population-based study. Journal of Nervous and Mental Disease, 201(11), 959–963. Scholar
  26. Hawkley, L. C., Preacher, K. J., & Cacioppo, J. T. (2007). Multilevel modeling of social interactions and mood in lonely and socially connected individuals: The MacArthur Social Neuroscience Studies.  In Ong, A. D., & van Dulmen, M. (Eds.), Oxford handbook of methods in positive psychology (pp. 559-575).  New York: Oxford University Press.Google Scholar
  27. Hayes, A. F. (2013). An introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: Guilford Press.Google Scholar
  28. Held, P., & Owens, G. P. (2015). Effects of self-compassion workbook training on trauma-related guilt in a sample of homeless veterans: a pilot study. Journal of Clinical Psychology, 71(6), 513–526. Scholar
  29. Hiraoka, R., Meyer, E. C., Kimbrel, N. A., DeBeer, B. B., Gulliver, S. B., & Morissette, S. B. (2015). Self-compassion as a prospective predictor of PTSD symptom severity among trauma-exposed U.S. Iraq and Afghanistan war veterans. Journal of Traumatic Stress, 28, 1–7. Scholar
  30. Hoffart, A., Øktedalen, T., & Langkaas, T. F. (2015). Self-compassion influences PTSD symptoms in the process of change in trauma-focused cognitive behavioral therapies: a study of within-person processes. Frontiers in Psychology, 6(1273).
  31. Horwitz, A. G., Czyz, E. K., & King, C. A. (2015). Predicting future suicide attempts among adolescent and emerging adult psychiatric emergency patients. Journal of Clinical Child and Adolescent Psychology, 44(5), 751–761. Scholar
  32. Izard, C. E. (1993). The Differential Emotions Scale: DES IV-A; A method of measuring the meaning of subjective experience of discrete emotions. Delaware: University of Delaware.Google Scholar
  33. Izard, C. E., Libero, D. Z., Putnam, P., & Haynes, O. M. (1993). Stability of emotion experiences and their relations to traits of personality. Journal of Personality and Social Psychology, 64(5), 847–860. Scholar
  34. Joeng, J. R., & Turner, S. L. (2015). Mediators between self-criticism and depression: fear of compassion, self-compassion, and importance to others. Journal of Counseling Psychology, 62(3), 453–463. Scholar
  35. Johnson, E. A., & O’Brien, K. A. (2013). Self-compassion soothes the savage EGO-threat system: effects on negative affect, shame, rumination, and depressive symptoms. Journal of Social and Clinical Psychology, 32(9), 939–963. Scholar
  36. Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.Google Scholar
  37. Katz, M. H. (2006). Multivariable analysis: A practical guide for clinicians. New York: Cambridge University Press.CrossRefGoogle Scholar
  38. Kearney, D. J., Malte, C. A., McManus, C., Martinez, M. E., Felleman, B., & Simpson, T. L. (2013). Loving-kindness meditation for posttraumatic stress disorder: a pilot study. Journal of Traumatic Stress, 26(4), 426–434. Scholar
  39. Kelliher Rabon, J., Sirois, F. M., & Hirsch, J. K. (2018). Self-compassion and suicidal behavior in college students: serial indirect effects via depression and wellness behaviors. Journal of American College Health, 66(2), 114–122. Scholar
  40. Kemp, J. E. & Bossarte, R. M. (2012). Suicide data report. Department of Veterans Affairs, Mental Health Services, Suicide Prevention Program.Google Scholar
  41. Kim, S., Thibodeau, R., & Jorgensen, R. S. (2011). Shame, guilt, and depressive symptoms: a meta-analytic review. Psychological Bulletin, 137, 68–96. Scholar
  42. Leary, M. R., Tate, E. B., Adams, C. E., Allen, A. B., & Hancock, J. (2007). Self-compassion and reactions to unpleasant self-relevant events: the implications of treating oneself kindly. Journal of Personality and Social Psychology, 92(5), 887–904. Scholar
  43. 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: a preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. Scholar
  44. Lockard, A. J., Hayes, J. A., Neff, K. D., & Locke, B. D. (2014). Self-compassion among college counseling center clients: an examination of clinical norms and group differences. Journal of College Counseling, 17, 249–259. Scholar
  45. Maheux, A., & Price, M. (2015). Investigation of the relation between PTSD symptoms and self-compassion: comparison across DSM IV and DSM 5 PTSD symptom clusters. Self and Identity, 14(6), 627–637. Scholar
  46. Mantzios, M. (2014). Exploring the relationship between worry and impulsivity in military recruits: the role of mindfulness and self-compassion as potential mediators. Stress and Health, 30, 397–404. Scholar
  47. Moberly, N. J., & Watkins, E. R. (2008). Ruminative self-focus and negative affect: an experience sampling study. Journal of Abnormal Psychology, 117(2), 314. Scholar
  48. National Center for Veterans Analysis and Statistics. (2016). Profile of veterans: 2014 data from the American Community Survey. United States Department of Veterans Affairs.Google Scholar
  49. Neff, K. D. (2003a). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223–250. Scholar
  50. Neff, K. D. (2003b). Self-compassion: an alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85–101. Scholar
  51. Osman, A., Bagge, C., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behavior Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples. Assessment, 8, 443–454. Scholar
  52. Pfeiffer, P. N., Brandfon, S., Garcia, E., Duffy, S., Ganoczy, D., Kim, H. M., & Valenstein, M. (2014). Predictors of suicidal ideation among depressed veterans and the interpersonal theory of suicide. Journal of Affective Disorders, 152, 277–281. Scholar
  53. Pietrzak, R. H., Russo, A. R., Ling, Q., & Southwick, S. M. (2011). Suicidal ideation in treatment-seeking veterans of operations enduring freedom and Iraqi freedom: the role of coping strategies, resilience, and social support. Journal of Psychiatric Research, 45, 720–726. Scholar
  54. Podsakoff, P. M., MacKenzie, S. B., Lee, J. Y., & Podsakoff, N. P. (2003). Common method biases in behavioral research: a critical review of the literature and recommended remedies. Journal of Applied Psychology, 88(5), 879. Scholar
  55. Pompili, M., Sher, L., Serafini, G., Forte, A., Innamorati, M., Dominici, G., et al. (2013). Posttraumatic stress disorder and suicide risk among veterans: a literature review. The Journal of Nervous and Mental Disease, 201(9), 802–812. Scholar
  56. Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891. Scholar
  57. Pressman, S. D., & Cohen, S. (2005). Does positive affect influence health? Psychological Bulletin, 131(6), 925–971. Scholar
  58. Raes, F. (2010). Rumination and worry as mediators of the relationship between self-compassion and depression and anxiety. Personality and Individual Differences, 48, 757–761. Scholar
  59. Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the Self-Compassion Scale. Clinical Psychology & Psychotherapy, 18, 250–255. Scholar
  60. Ramírez, J. M., & Andreu, J. M. (2006). Aggression, and some related psychological constructs (anger, hostility, and impulsivity); some comments from a research project. Neuroscience and Biobehavioral Reviews, 30(3), 276–291. Scholar
  61. Renshaw, K. D., & Kiddie, N. S. (2012). Internal anger and external expression of aggression in OEF/OIF veterans. Military Psychology, 24, 221–235. Scholar
  62. Rudd, M. D., Goulding, J., & Bryan, C. J. (2011). Student veterans: a national survey exploring psychological symptoms and suicide risk. Professional Psychology: Research and Practice, 42, 354–360. Scholar
  63. Ruehlman, L. S., Lanyon, R. I., & Karoly, P. (1998). Multidimensional health profile: professional manual. Odessa: Psychological Assessment Resources.Google Scholar
  64. Selby, E. A., Anestis, M. D., Bender, T. W., Ribeiro, J. D., Nick, M. K., Rudd, M. D., et al. (2010). Overcoming the fear of lethal injury: evaluating suicidal behavior in the military through the lens of the interpersonal-psychological theory of suicide. Clinical Psychology Review, 30(3), 298–307. Scholar
  65. Shepperd, J. A., Waters, E., Weinstein, N. D., & Klein, W. M. P. (2015). A primer on unrealistic optimism. Current Directions in Psychological Science, 24(3), 232–237. Scholar
  66. Sirois, F. M., Kitner, R., & Hirsch, J. K. (2015a). Self-compassion, affect, and health-promoting behaviors. Health Psychology, 34(6), 661–669. Scholar
  67. Sirois, F. M., Molnar, D. S., & Hirsch, J. K. (2015b). Self-compassion, stress, and coping in the context of chronic illness. Self and Identity, 3. Scholar
  68. Tanner, K., Pugh, K. C., Britton, P., Pigeon, W., Sirois, F., & Hirsch, J. K. (2018). Insomnia and suicide risk in veterans: conditional indirect effects of perceived burdensomeness and self-compassion. Manuscript submitted for publication.Google Scholar
  69. Thompson, B. L., & Waltz, J. (2008). Self-compassion and PTSD symptom severity. Journal of Traumatic Stress, 21, 556-558. Scholar
  70. Tielke, S. (2016). The relationship of self-compassion with thwarted belongingness and perceived burdensomeness in American Indian/Alaska Native people (Doctoral dissertation, Oklahoma State University).Google Scholar
  71. Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600. Scholar
  72. Van Orden, K. A., Cukrowicz, K. C., Witte, T. K., & Joiner, T. E. (2012). Thwarted belongingness and perceived burdensomeness: construct validity and psychometric properties of the Interpersonal Needs Questionnaire. Psychological Assessment, 24, 197–215. Scholar
  73. Weathers, F., Huska, J., & Keane, T. (1991). The PTSD checklist military version (PCL-M). Boston: National Center for PTSD.Google Scholar
  74. Williams, J. L., McDevitt-Murphy, M. E., Fields, J. A., Weathers, F. W., & Flood, A. M. (2011). A comparison of multidimensional health profiles across three trauma-exposed diagnostic groups. Journal of Psychopathology and Behavioral Assessment, 33, 531–539. Scholar
  75. Yarvis, J. S., & Schiess, L. (2008). Subthreshold posttraumatic stress disorder (PTSD) as a predictor of depression, alcohol use, and health problems in veterans. Journal of Workplace Behavioral Health, 23(4), 395–424.CrossRefGoogle Scholar
  76. Yarvis, J. S., Yoon, E., Amenuke, M., Simien-Turner, S., & Landers, G. D. (2012). Assessment of PTSD in older veterans: the Posttraumatic Stress Disorder Checklist: Military Version (PCL-M). Advances in Social Work, 13(1), 185–202.CrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Prisma HealthColumbiaUSA
  2. 2.Department of PsychologyEast Tennessee State UniversityJohnson CityUSA
  3. 3.Department of Public Health SciencesUniversity of North Carolina CharlotteCharlotteUSA
  4. 4.Department of PsychologyUniversity of SheffieldSheffieldUK
  5. 5.Department of Educational PsychologyUniversity of Texas at AustinAustinUSA

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