Skip to main content
Erschienen in: Current Psychiatry Reports 11/2018

01.11.2018 | Disaster Psychiatry: Trauma, PTSD, and Related Disorders (M J Friedman, Section Editor)

Posttraumatic Stress Disorder and Death From Suicide

verfasst von: Jaimie L. Gradus

Erschienen in: Current Psychiatry Reports | Ausgabe 11/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

This review summarizes the increasing public health concern about PTSD and suicide, and the population-based studies that have examined this association. Further, we discuss methodological issues that provide important context for the examination of this association.

Recent Findings

The majority of epidemiologic studies have shown that PTSD is associated with an increased risk of suicide; however, a notable minority of studies have documented a decreased risk of suicide among persons with PTSD. Methodological (e.g., sample size and misclassification) and etiologic issues (e.g., complicated psychiatric comorbidity) may explain the conflicting evidence.

Summary

PTSD may be associated with an increased risk of suicide, but further research is needed. Increasing the use of appropriate methods (e.g., marginal structural models that can evaluate both confounding and effect modification, machine learning methods, quantification of systematic error) will strengthen the evidence base and advance our understanding.
Literatur
1.
Zurück zum Zitat Power AK, McKeon R. Preventing suicide is a national imperative. Am J Public Health. 2012;102(Suppl 1):S7.CrossRef Power AK, McKeon R. Preventing suicide is a national imperative. Am J Public Health. 2012;102(Suppl 1):S7.CrossRef
4.
Zurück zum Zitat Reger MA, Smolenski DJ, Skopp NA, Metzger-Abamukang MJ, Kang HK, Bullman TA, et al. Risk of suicide among US military service members following Operation Enduring Freedom or Operation Iraqi Freedom deployment and separation from the US military. JAMA psychiatry. 2015;72(6):561–9.CrossRef Reger MA, Smolenski DJ, Skopp NA, Metzger-Abamukang MJ, Kang HK, Bullman TA, et al. Risk of suicide among US military service members following Operation Enduring Freedom or Operation Iraqi Freedom deployment and separation from the US military. JAMA psychiatry. 2015;72(6):561–9.CrossRef
5.
Zurück zum Zitat Kuehn BM. Soldier suicide rates continue to rise: military, scientists work to stem the tide. JAMA. 2009;301(11):1111–3.CrossRef Kuehn BM. Soldier suicide rates continue to rise: military, scientists work to stem the tide. JAMA. 2009;301(11):1111–3.CrossRef
6.
Zurück zum Zitat Program VSP. Facts about veterans suicide. In: Affairs DoV, editor. 2016. Program VSP. Facts about veterans suicide. In: Affairs DoV, editor. 2016.
8.
Zurück zum Zitat Maris RW, Berman AL, Silverman MM. Introduction to the study of suicide. In: Comprehensive textbook of suicidology. New York: Guilford Press; 2000. p. 3–25. Maris RW, Berman AL, Silverman MM. Introduction to the study of suicide. In: Comprehensive textbook of suicidology. New York: Guilford Press; 2000. p. 3–25.
9.
Zurück zum Zitat Koven SG. PTSD and suicides among veterans—recent findings. Public Integrity. 2017;19(5):500–12.CrossRef Koven SG. PTSD and suicides among veterans—recent findings. Public Integrity. 2017;19(5):500–12.CrossRef
10.
Zurück zum Zitat Gradus JL. PTSD and death from suicide. PTSD Research Quarterly 2017;28(4). Gradus JL. PTSD and death from suicide. PTSD Research Quarterly 2017;28(4).
11.
Zurück zum Zitat Panagioti M, Gooding P, Tarrier N. Post-traumatic stress disorder and suicidal behavior: a narrative review. Clin Psychol Rev. 2009;29(6):471–82.CrossRef Panagioti M, Gooding P, Tarrier N. Post-traumatic stress disorder and suicidal behavior: a narrative review. Clin Psychol Rev. 2009;29(6):471–82.CrossRef
12.
Zurück zum Zitat Krysinska K, Lester D. Post-traumatic stress disorder and suicide risk: a systematic review. Archives of Suicide Research. 2010;14(1):1–23.CrossRef Krysinska K, Lester D. Post-traumatic stress disorder and suicide risk: a systematic review. Archives of Suicide Research. 2010;14(1):1–23.CrossRef
13.
Zurück zum Zitat • Hyman J, Ireland R, Frost L, Cottrell L. Suicide incidence and risk factors in an active duty US military population. Am J Public Health. 2012;102(S1):S138–S46. This study included the entire active duty military population in 2005 and 2007 and found that PTSD was associated with an increased risk of suicide among members of the Army and the Air Force; however, the effect of comorbid psychopathology was not considered. CrossRef • Hyman J, Ireland R, Frost L, Cottrell L. Suicide incidence and risk factors in an active duty US military population. Am J Public Health. 2012;102(S1):S138–S46. This study included the entire active duty military population in 2005 and 2007 and found that PTSD was associated with an increased risk of suicide among members of the Army and the Air Force; however, the effect of comorbid psychopathology was not considered. CrossRef
14.
Zurück zum Zitat Black SA, Gallway MS, Bell MR, Ritchie EC. Prevalence and risk factors associated with suicides of army soldiers 2001-2009. Mil Psychol. 2011;23(4):433–51. Black SA, Gallway MS, Bell MR, Ritchie EC. Prevalence and risk factors associated with suicides of army soldiers 2001-2009. Mil Psychol. 2011;23(4):433–51.
15.
Zurück zum Zitat Bachynski KE, Canham-Chervak M, Black SA, Dada EO, Millikan AM, Jones BH. Mental health risk factors for suicides in the US Army, 2007–8. Injury Prevention 2012:injuryprev-2011-040112. Bachynski KE, Canham-Chervak M, Black SA, Dada EO, Millikan AM, Jones BH. Mental health risk factors for suicides in the US Army, 2007–8. Injury Prevention 2012:injuryprev-2011-040112.
16.
Zurück zum Zitat • LeardMann CA, Powell TM, Smith TC, Bell MR, Smith B, Boyko EJ, et al. Risk factors associated with suicide in current and former US military personnel. JAMA. 2013;310:496–560. This study used data from the Millenium Cohort Study to examine risk factors for suicide. Although PTSD was associated with an increased risk of suicide in unadjustment and age and sex adjusted models, the authors did not include it in the multivarite adjusted models because this association was not statistically significant. CrossRef • LeardMann CA, Powell TM, Smith TC, Bell MR, Smith B, Boyko EJ, et al. Risk factors associated with suicide in current and former US military personnel. JAMA. 2013;310:496–560. This study used data from the Millenium Cohort Study to examine risk factors for suicide. Although PTSD was associated with an increased risk of suicide in unadjustment and age and sex adjusted models, the authors did not include it in the multivarite adjusted models because this association was not statistically significant. CrossRef
17.
Zurück zum Zitat O’Donnell ML, Creamer M, Pattison P. Posttraumatic stress disorder and depression following trauma: understanding comorbidity. Am J Psychiatry. 2004;161(8):1390–6.CrossRef O’Donnell ML, Creamer M, Pattison P. Posttraumatic stress disorder and depression following trauma: understanding comorbidity. Am J Psychiatry. 2004;161(8):1390–6.CrossRef
18.
Zurück zum Zitat Gradus JL. Prevalence and prognosis of stress disorders: a review of the epidemiologic literature. Clin Epidemiol. 2017;9:251–60.CrossRef Gradus JL. Prevalence and prognosis of stress disorders: a review of the epidemiologic literature. Clin Epidemiol. 2017;9:251–60.CrossRef
19.
Zurück zum Zitat • Shen Y-C, Cunha JM, Williams TV. Time-varying associations of suicide with deployments, mental health conditions, and stressful life events among current and former US military personnel: a retrospective multivariate analysis. The Lancet Psychiatry. 2016;3(11):1039–48. In this study of all military personnel from 2001 through 2011, PTSD was associated with a decreased risk of death from suicide, after adjustment for psychiatric comorbidity, across all time intervals examined. CrossRef • Shen Y-C, Cunha JM, Williams TV. Time-varying associations of suicide with deployments, mental health conditions, and stressful life events among current and former US military personnel: a retrospective multivariate analysis. The Lancet Psychiatry. 2016;3(11):1039–48. In this study of all military personnel from 2001 through 2011, PTSD was associated with a decreased risk of death from suicide, after adjustment for psychiatric comorbidity, across all time intervals examined. CrossRef
20.
Zurück zum Zitat Bullman TA, Kang HK. Posttraumatic stress disorder and the risk of traumatic deaths among Vietnam veterans. J Nerv Ment Dis. 1994;182(11):604–10.CrossRef Bullman TA, Kang HK. Posttraumatic stress disorder and the risk of traumatic deaths among Vietnam veterans. J Nerv Ment Dis. 1994;182(11):604–10.CrossRef
21.
Zurück zum Zitat •• Ilgen MA, Bohnert ASB, Ignacio RV, McCarthy JF, Valenstein MM, Kim HM, et al. Psychiatric diagnoses and risk of suicide in veterans. Arch Gen Psychiatry. 2010;67(11):1152–8. This study documented associations between many psychiatric diagnoses, including PTSD, and suicide in the full population of patients who received treatment at the VA in fiscal year 1999. CrossRef •• Ilgen MA, Bohnert ASB, Ignacio RV, McCarthy JF, Valenstein MM, Kim HM, et al. Psychiatric diagnoses and risk of suicide in veterans. Arch Gen Psychiatry. 2010;67(11):1152–8. This study documented associations between many psychiatric diagnoses, including PTSD, and suicide in the full population of patients who received treatment at the VA in fiscal year 1999. CrossRef
22.
Zurück zum Zitat Ilgen MA, McCarthy JF, Ignacio RV, Bohnert ASB, Valenstein M, Blow FC, et al. Psychopathology, Iraq and Afghanistan service, and suicide among Veterans Health Administration patients. J Consult Clin Psychol. 2012;80:323–30.CrossRef Ilgen MA, McCarthy JF, Ignacio RV, Bohnert ASB, Valenstein M, Blow FC, et al. Psychopathology, Iraq and Afghanistan service, and suicide among Veterans Health Administration patients. J Consult Clin Psychol. 2012;80:323–30.CrossRef
23.
Zurück zum Zitat • Conner KR, Bossarte R, Lu N, Bohnert ASB, McCarthy JF, Ignacio RV, et al. Mental disorder comorbidity and suicide among 2.96 million men receiving care in the Veterans Health Administration system. J Abnorm Psychol. 2013;122(1):256–63. This study, of all VA patients in fiscal year 1999, found that persons with PTSD and no comorbid diagnoses had 1.6 times the rate of suicide than persons without PTSD. CrossRef • Conner KR, Bossarte R, Lu N, Bohnert ASB, McCarthy JF, Ignacio RV, et al. Mental disorder comorbidity and suicide among 2.96 million men receiving care in the Veterans Health Administration system. J Abnorm Psychol. 2013;122(1):256–63. This study, of all VA patients in fiscal year 1999, found that persons with PTSD and no comorbid diagnoses had 1.6 times the rate of suicide than persons without PTSD. CrossRef
24.
Zurück zum Zitat •• Conner KR, Bossarte RM, He H, Arora J, Lu N, Tu XM, et al. Posttraumatic stress disorder and suicide in 5.9 million individuals receiving care in the Veterans Health Administration system. J Affect Disord. 2014;166:1–5. This paper documented an increased risk of suicide among persons with PTSD in a sample of all patients who received VA care in fiscal year 2007. After adjustment for other psychiatric diagnoses, however, results showed that PTSD was associated with a decreased risk of suicide. CrossRef •• Conner KR, Bossarte RM, He H, Arora J, Lu N, Tu XM, et al. Posttraumatic stress disorder and suicide in 5.9 million individuals receiving care in the Veterans Health Administration system. J Affect Disord. 2014;166:1–5. This paper documented an increased risk of suicide among persons with PTSD in a sample of all patients who received VA care in fiscal year 2007. After adjustment for other psychiatric diagnoses, however, results showed that PTSD was associated with a decreased risk of suicide. CrossRef
25.
Zurück zum Zitat Desai RA, Dausey D, Rosenheck RA. Suicide among discharged psychiatric inpatients in the Department of Veterans Affairs. Mil Med. 2008;173(8):721–8.CrossRef Desai RA, Dausey D, Rosenheck RA. Suicide among discharged psychiatric inpatients in the Department of Veterans Affairs. Mil Med. 2008;173(8):721–8.CrossRef
26.
Zurück zum Zitat Britton PC, Bohnert KM, Ilgen MA, Kane C, Stephens B, Pigeon WR. Suicide mortality among male veterans discharged from Veterans Health Administration acute psychiatric units from 2005 to 2010. Soc Psychiatry Psychiatr Epidemiol 2017 1–7. Britton PC, Bohnert KM, Ilgen MA, Kane C, Stephens B, Pigeon WR. Suicide mortality among male veterans discharged from Veterans Health Administration acute psychiatric units from 2005 to 2010. Soc Psychiatry Psychiatr Epidemiol 2017 1–7.
27.
Zurück zum Zitat •• Zivin K, Kim HM, McCarthy JF, Austin KL, Hoggatt KJ, Walters H, et al. Suicide mortality among individuals receiving treatment for depression in the Veterans Affairs health system: associations with patient and treatment setting characteristics. Am J Public Health. 2007;97(12):2193–8. This study is frequently cited as evidence that PTSD is associated with a decreased risk of death from suicide. CrossRef •• Zivin K, Kim HM, McCarthy JF, Austin KL, Hoggatt KJ, Walters H, et al. Suicide mortality among individuals receiving treatment for depression in the Veterans Affairs health system: associations with patient and treatment setting characteristics. Am J Public Health. 2007;97(12):2193–8. This study is frequently cited as evidence that PTSD is associated with a decreased risk of death from suicide. CrossRef
28.
Zurück zum Zitat •• Bullman T, Schneiderman A, Gradus JL. Relative importance of posttraumatic stress disorder and depression in predicting risk of suicide among a cohort of Vietnam veterans. Suicide and Life-Threatening Behavior. 2018. This study examined PTSD and depression as predictors of death from suicide among veterans, and demonstrated that PTSD is associated with an increased risk of suicide, but when the refernt group is changed to persons with depression, it appears that PTSD is associated with a decreased risk of suicide. •• Bullman T, Schneiderman A, Gradus JL. Relative importance of posttraumatic stress disorder and depression in predicting risk of suicide among a cohort of Vietnam veterans. Suicide and Life-Threatening Behavior. 2018. This study examined PTSD and depression as predictors of death from suicide among veterans, and demonstrated that PTSD is associated with an increased risk of suicide, but when the refernt group is changed to persons with depression, it appears that PTSD is associated with a decreased risk of suicide.
29.
Zurück zum Zitat Gradus JL, Qin P, Lincoln AK, Miller M, Lawler E, Sørensen HT, et al. Posttraumatic stress disorder and completed suicide. Am J Epidemiol. 2010;171(6):721–7.CrossRef Gradus JL, Qin P, Lincoln AK, Miller M, Lawler E, Sørensen HT, et al. Posttraumatic stress disorder and completed suicide. Am J Epidemiol. 2010;171(6):721–7.CrossRef
30.
Zurück zum Zitat •• Gradus JL, Antonsen S, Svensson E, Lash TL, Resick PA, Hansen JG. Trauma, comorbidity, and mortality following diagnoses of severe stress and adjustment disorders: a nationwide cohort study. Am J Epidemiol. 2015(182):451–8. This is the largest general population study to date to document an association between PTSD and death from suicide. CrossRef •• Gradus JL, Antonsen S, Svensson E, Lash TL, Resick PA, Hansen JG. Trauma, comorbidity, and mortality following diagnoses of severe stress and adjustment disorders: a nationwide cohort study. Am J Epidemiol. 2015(182):451–8. This is the largest general population study to date to document an association between PTSD and death from suicide. CrossRef
31.
Zurück zum Zitat Rothman KJ, Greenland S, Lash TL. Validity in epidemiologic studies. 3rd edition. Philadelphia: Lippincott, Williams and Wilkins; 2008. Rothman KJ, Greenland S, Lash TL. Validity in epidemiologic studies. 3rd edition. Philadelphia: Lippincott, Williams and Wilkins; 2008.
32.
Zurück zum Zitat CDC. Health, United States, 2016. National Center for Health Statistics; 2016. CDC. Health, United States, 2016. National Center for Health Statistics; 2016.
33.
Zurück zum Zitat Mooney SJ, Westreich DJ, El-Sayed AM. Epidemiology in the era of big data. Epidemiology (Cambridge, Mass). 2015;26(3):390–4.CrossRef Mooney SJ, Westreich DJ, El-Sayed AM. Epidemiology in the era of big data. Epidemiology (Cambridge, Mass). 2015;26(3):390–4.CrossRef
34.
Zurück zum Zitat Khoury MJ. Planning for the future of epidemiology in the era of big data and precision medicine. Am J Epidemiol. 2015;182(12):977–9.PubMedPubMedCentral Khoury MJ. Planning for the future of epidemiology in the era of big data and precision medicine. Am J Epidemiol. 2015;182(12):977–9.PubMedPubMedCentral
35.
Zurück zum Zitat Rockett IR. Counting suicides and making suicide count as a public health problem. Hogrefe Publishing 2010. Rockett IR. Counting suicides and making suicide count as a public health problem. Hogrefe Publishing 2010.
36.
Zurück zum Zitat Rockett IR, Samora JB, Coben JH. The black–white suicide paradox: possible effects of misclassification. Soc Sci Med. 2006;63(8):2165–75.CrossRef Rockett IR, Samora JB, Coben JH. The black–white suicide paradox: possible effects of misclassification. Soc Sci Med. 2006;63(8):2165–75.CrossRef
37.
Zurück zum Zitat Lash TL, Fox MP, Fink AK. Applying quantitative bias analysis to epidemiologic data. New York: Springer; 2009.CrossRef Lash TL, Fox MP, Fink AK. Applying quantitative bias analysis to epidemiologic data. New York: Springer; 2009.CrossRef
38.
Zurück zum Zitat Greenland S, Lash TL. Bias Analysis. In: Rothman KJ, Greenland S, Lash TL, editors. Modern epidemiology. 3rd ed. Philadelphia: Lippincott, Williams & Wilkins; 2008. p. 345–80. Greenland S, Lash TL. Bias Analysis. In: Rothman KJ, Greenland S, Lash TL, editors. Modern epidemiology. 3rd ed. Philadelphia: Lippincott, Williams & Wilkins; 2008. p. 345–80.
Metadaten
Titel
Posttraumatic Stress Disorder and Death From Suicide
verfasst von
Jaimie L. Gradus
Publikationsdatum
01.11.2018
Verlag
Springer US
Erschienen in
Current Psychiatry Reports / Ausgabe 11/2018
Print ISSN: 1523-3812
Elektronische ISSN: 1535-1645
DOI
https://doi.org/10.1007/s11920-018-0965-0

Weitere Artikel der Ausgabe 11/2018

Current Psychiatry Reports 11/2018 Zur Ausgabe

Child and Adolescent Disorders (T Benton, Section Editor)

Autism Spectrum Disorder and Transition-Aged Youth

Sex and Gender Issues in Behavioral Health (CN Epperson and L Hantsoo, Section Editors)

Sex Differences in Vulnerability to Prenatal Stress: a Review of the Recent Literature

Complex Medical-Psychiatric Issues (M Riba, Section Editor)

The Impact of Psychotropic Medications on Bone Health in Youth

Reproductive Psychiatry and Women's Health (CN Epperson and L Hantsoo, Section Editors)

Examining the Relationship Between Neurosteroids, Cognition, and Menopause With Neuroimaging Methods

Disaster Psychiatry: Trauma, PTSD, and Related Disorders (MJ Friedman, Section Editor)

Neurocognitive and Information Processing Biases in Posttraumatic Stress Disorder

Update Psychiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.