Post-Traumatic Stress Disorder and Suicide Risk: A Systematic Review

Abstract

There is a gap in the literature regarding suicide risk among traumatized individuals with post-traumatic stress disorder (PTSD) and this article aims to systematically review literature on the relationship between PTSD and suicidal behavior and ideation. A meta-analysis of 50 articles that examined the association between PTSD and past and current suicidal ideation and behavior was conducted. There was no evidence for an increased risk of completed suicide in individuals with PTSD. PTSD was associated with an increased incidence of prior attempted suicide and prior and current suicidal ideation. Controlling for other psychiatric disorders (including depression) weakened, but did not eliminate, this association. The evidence indicates that there is an association between PTSD and suicidality with several factors, such as concurrent depression and the pre-trauma psychiatric condition, possibly mediating this relationship. There are significant clinical implications of the reported relationship for suicide risk assessment and therapy, and further studies might help to understand the mediating pathways between PTSD and increased suicide risk.

Keywords:

• post-traumatic stress disorder
• psychiatric comorbidity
• suicide risk
• trauma

Notes

Note. ¹This is the same sample as in Kessler et al. (1999) but with different odds ratios.

APS: Adolescent Psychopathology Scale (Reynolds, 1998); BSI: Brief Symptom Inventory (Derogatis, 1992); CAPS: Clinician Administered PTSD Scale (Blake et al., 1990); CIDI: Composite International Diagnostic Interview (World Health Organization, 1990); DIS: Diagnostic Interview Schedule (Robins et al., 1981); HDS: Hamilton Depression Scale (Hamilton 1960); IES: Impact of Events Scale (Horowitz et al., 1979); PC-PTSD: Primary Care PTSD Screen (Prins et al., 2004); PCL: PTSD Checklist (Blanchard et al., 1996); SADS-L: Schedule for Affective Disorders and Schizophrenia-Lifetime (Endicott & Spitzer, 1978); SCID: Structured Clinical Interview for DSM (Spitzer et al., 1986); SIQ: Suicidal Ideation Questionnaire-Junior (Reynolds, 1987); SRS: Suicide Risk Scale (Plutchik et al., 1989); SSI: Scale for Suicide Ideation (Beck & Kovacs, 1979); TES: Traumatic Experiences Scale (Murphy et al., 2003); AS: attempted suicide; CS: completed suicide; DVA: Department of Veterans' Affairs; ER: Emergency Room; FDA: Food and Drug Administration; IPV: Intimate partner violence; MR: multiple regression; POW: Prisoners of war; PY: persons-years; SA: substance abuse; SD: substance dependence; SI: self-inflicted injury; Ss: subjects; WW2: World War 2.

Note. CAPS: Clinician Administered PTSD Scale (Blake et al., 1990); GHQ: General Health Questionnaire 28 (Goldberg & Williams, 1988); SIPS: Structured Interview for PTSD (Keane et al., 1988); AS: attempted suicide.

Additional information

Notes on contributors

David Lester

David Lester, Distinguished Professor of Psychology, The Richard Stockton College of New Jersey, Pomona, NJ, USA.