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Although killing in combat is associated with negative mental health outcomes and hazardous alcohol use, mechanisms that underlie this risk are not well understood. To our knowledge, this present brief report is the first to use mediation analysis to examine associations between killing in combat, distinct facets of rumination (problem-focused thoughts, counterfactual thinking, repetitive thoughts, and anticipatory thoughts), and negative mental health outcomes (i.e., depression, anxiety, PTSD, suicidality) and hazardous alcohol use.

Killing during combat and negative mental health and substance use outcomes among recent-era veterans: The mediating effects of rumination.