Evaluation of the critical warzone experiences scale among Gulf War I-era veterans: Associations with PTSD symptoms, depressive symptoms, and suicidal thoughts and behaviors

ABSTRACT

Prior research has established the psychometric properties of the Critical Warzone Experiences (CWE) scale among post-9/11 Iraq/Afghanistan-era veterans; however, the psychometric properties of the CWE among Gulf War I-era veterans have not yet been established. The first objective of the present study was to examine the psychometric properties of the CWE among Gulf War I-era veterans. The second objective was to test the hypothesis that the CWE would have a significant indirect effect on suicidal thoughts and behaviors via posttraumatic stress disorder (PTSD) and depressive symptoms. To test these hypotheses, a survey packet that included the CWE and measures of PTSD symptoms, depressive symptoms, and suicidal thoughts and behaviors was administered to 1,153 Gulf War I-era veterans. Consistent with prior research in post-9/11 Iraq/Afghanistan-era veterans, the CWE exhibited good internal consistency (α = .85), a unidimensional factor structure (RMSEA = .056, CFI = .959, SRMR = .033; average factor loading = .69), and good concurrent validity with PTSD (r = .47, p < .001) and depressive (r = .31, p < .001) symptoms among Gulf War I-era veterans. Additionally, as hypothesized, a significant indirect effect from the CWE to suicidal thoughts and behaviors via PTSD and depressive symptoms (β = .35, p < .001) was also observed. Taken together, our findings provide strong support for using the CWE with Gulf War I-era veterans.

KEYWORDS:

• Combat
• trauma
• PTSD
• depression
• suicide

Acknowledgments

This research was supported by Merit Award #I01HX001682 to Drs. Kimbrel and Pugh from the Health Services Research and Development Service of the Department of Veterans Affairs’ Office of Research and Development (VA ORD). Drs. Pugh (IK6HX002608) and Beckham (lK6BX003777) were supported by Research Career Scientist Awards from the Health Services and Clinical Sciences Research and Development Services, respectively, of VA ORD. This work was also supported by the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Health Care System, the IDEAS 2.0 Center of Innovation at the VA Salt Lake City Health Care System, the VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), and the Mental Health and Research Service Lines of the Durham VA Health Care System. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the VA or the United States government.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, [NAK], upon reasonable request and with written approval of the Durham VA Health Care System Institutional Review Board.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/08995605.2024.2357993.

Additional information

Funding

The work was supported by the U.S. Department of Veterans Affairs [I01HX001682]; U.S. Department of Veterans Affairs [lK6BX003777]; U.S. Department of Veterans Affairs [IK6HX002608].