Sleep, PTSD, and suicide risk in U.S. veterans

Front Sleep. 2026 Jun 25;5:1837234. doi: 10.3389/frsle.2026.1837234. eCollection 2026.

ABSTRACT

INTRODUCTION: The stresses of military service can contribute independently to mental health and sleep problems in military personnel that persist after leaving military service. Understanding how sleep and mental health challenges contribute to behavioral health outcomes is key to supporting this population. To advance these goals, this study examined associations among PTSD, sleep disturbance, and suicide risk in U.S. veterans.

METHODS: Online survey data using valid and reliable measures were collected from3,188 veterans living in Southern California as part of a large needs assessment; suicide risk was measured by the SBQ-R, which assess ideation, behaviors and attempts. A structural equation modeling approach was used to test the direct effects of PTSD on sleep problems and suicide risk, the direct effect of sleep on suicide risk, and an indirect effect of PTSD on suicide risk through the sleep pathway.

RESULTS: Findings demonstrated significant direct effects for PTSD (B = 0.05, p < 0.001) and sleep problems (B = 0.74, p < 0.001) on suicide risk, as well as a significant indirect effect for PTSD on suicide risk through the sleep pathway (B = 0.05, p < 0.05). The structural model explained 55.3% of the variance in sleep difficulties and 29.9% of the variance in suicide risk.

DISCUSSION: Results advance the understanding of how sleep problems may be associated with the risk of suicide in U.S. veterans, both directly through its effects on suicide risk and indirectly through the effects on PTSD symptomatology. Practitioners and policy makers may consider ensuring the assessment and treatment of sleep problems in veterans are included in suicide prevention models.

PMID:42428042 | PMC:PMC13346184 | DOI:10.3389/frsle.2026.1837234