Social integration and social contribution moderate the moral injury suicidality link among veterans.

Moral injury, arising from perceived violations of deeply held moral beliefs, is a significant risk factor for suicidality among veterans. Consistent with the buffering hypothesis, factors associated with social well-being may attenuate this relationship. This study tested whether two facets of social well-being, specifically social integration (i.e., feeling connected) and social contribution (i.e., believing one's actions matter), combine to moderate the moral injury-suicidality relationship. Using data previously collected from 1469 veterans who participated in the Military Mental Health and Well-being Project, a moderated-moderation regression analysis revealed a significant three-way interaction: the moral injury-suicidality link was strongest when both social integration and social contribution were low and weakest when both social integration and social contribution were high. Supplemental analyses using each of the four suicidality items as a separate outcome showed a highly consistent buffering pattern across lifetime ideation/attempt history, past-year ideation, suicide communications, and anticipated future suicide risk. Findings suggest that social integration and social contribution may represent promising targets for intervention research aimed at reducing suicidality among veterans experiencing symptoms of moral injury.