Abstract
Objective: The specific role of posttraumatic stress disorder (PTSD) in individuals who have attempted suicide, along with the influence of comorbid psychiatric conditions on the risk of suicide reattempt, remains unexplored. This study aims to assess the association between PTSD and suicide reattempt at 6 months among suicide attempt (SA) survivors, while controlling for prevalent psychiatric disorders.
Method: We analyzed data from a cohort of 972 participants enrolled in the ALGOS study between January 2010 and February 2013. We assessed the risk of suicide reattempt at 6 months and rehospitalization in both psychiatric and nonpsychiatric settings. A multivariable logistic regression model was performed, controlling for depression, generalized anxiety disorder, and alcohol use disorder.
Results: Among all participants, 79 had a lifetime diagnosis of PTSD. At 6 months, 117 participants (13.3%) had reattempted suicide. After controlling for randomization group, age, sex, and comorbid psychiatric conditions, PTSD was statistically associated with suicide reattempt at 6 months (odds ratio [OR] with 95% CI, 2.33 [1.39–3.89], P < .01), rehospitalization in psychiatric settings (OR = 2.24 [1.39–3.61], P < .01), and nonpsychiatric settings (OR = 3.06 [1.90–4.93], P < .01).
Conclusion: Almost 1 in 10 SA survivors suffer from PTSD. These individuals are at a higher risk of suicide reattempt and appear more generally to be in poorer health, with a higher risk of hospitalization in psychiatric and nonpsychiatric settings. Recognizing and effectively managing PTSD among individuals admitted after an SA is thus imperative for reducing the risk of subsequent suicide reattempts.
J Clin Psychiatry 2024;85(4):24m15269
Author affiliations are listed at the end of this article.
Continue Reading...
Did you know members enjoy unlimited free PDF downloads as part of their subscription? Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.
References (45)
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Association; 2013.
- Fox V, Dalman C, Dal H, et al. Suicide risk in people with post-traumatic stress disorder: a cohort study of 3.1 million people in Sweden. J Affect Disord. 2021;279:609–616. PubMed CrossRef
- Sareen J, Cox BJ, Stein MB, et al. Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosom Med. 2007;69(3):242–248. PubMed CrossRef
- Karam EG, Friedman MJ, Hill ED, et al. Cumulative traumas and risk thresholds: 12-month PTSD in the World Mental Health (WMH) surveys. Depress Anxiety. 2014;31(2):130–142. PubMed
- Nilaweera D, Phyo AZZ, Teshale AB, et al. Lifetime posttraumatic stress disorder as a predictor of mortality: a systematic review and meta-analysis. BMC Psychiatry. 2023;23(1):229. PubMed
- Ahmadi N, Hajsadeghi F, Mirshkarlo HB, et al. Post-traumatic stress disorder, coronary atherosclerosis, and mortality. Am J Cardiol. 2011;108(1):29–33. PubMed
- Song H, Fang F, Arnberg FK, et al. Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study. BMJ. 2019;365:l1255. PubMed CrossRef
- Krysinska K, Lester D. Post-traumatic stress disorder and suicide risk: a systematic review. Arch Suicide Res. 2010;14(1):1–23. PubMed
- Panagioti M, Gooding PA, Tarrier N. A meta-analysis of the association between posttraumatic stress disorder and suicidality: the role of comorbid depression. Compr Psychiatry. 2012;53(7):915–930. PubMed CrossRef
- Akbar R, Arya V, Conroy E, et al. Posttraumatic stress disorder and risk of suicidal behavior: a systematic review and meta-analysis. Suicide Life Threat Behav. 2023;53(1):163–184. PubMed CrossRef
- Koenen KC, Ratanatharathorn A, Ng L, et al. Posttraumatic stress disorder in the world mental health surveys. Psychol Med. 2017;47(13):2260–2274. PubMed CrossRef
- Bryant RA. Post-traumatic stress disorder: a state-of-the-art review of evidence and challenges. World Psychiatry. 2019;18(3):259–269. PubMed CrossRef
- Fazel S, Runeson B. Suicide. N Engl J Med. 2020;382(3):266–274. PubMed CrossRef
- Zhang Y, Wang J, Xiong X, et al. Suicidality in patients with primary diagnosis of panic disorder: a single-rate meta-analysis and systematic review. J Affect Disord. 2022;300:27–33. PubMed
- Du J, Diao H, Zhou X, et al. Post-traumatic stress disorder: a psychiatric disorder requiring urgent attention. Med Rev (2021). 2022;2(3):219–243. PubMed CrossRef
- Beghi M, Rosenbaum JF, Cerri C, et al. Risk factors for fatal and nonfatal repetition of suicide attempts: a literature review. Neuropsychiatr Dis Treat. 2013;9:1725–1736. PubMed CrossRef
- Park S, Lee Y, Youn T, et al. Association between level of suicide risk, characteristics of suicide attempts, and mental disorders among suicide attempters. BMC Public Health. 2018;18(1):477. PubMed
- Monnin J, Thiemard E, Vandel P, et al. Sociodemographic and psychopathological risk factors in repeated suicide attempts: gender differences in a prospective study. J Affect Disord. 2012;136(1–2):35–43. PubMed
- Baltjes F, Cook JM, van Kordenoordt M, et al. Psychiatric comorbidities in older adults with posttraumatic stress disorder: a systematic review. Int J Geriatr Psychiatry. 2023;38(6):e5947. PubMed CrossRef
- Yehuda R, Hoge CW, McFarlane AC, et al. Post-traumatic stress disorder. Nat Rev Dis Primers. 2015;1:15057. PubMed CrossRef
- Edmondson D, Kronish IM, Shaffer JA, et al. Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review. Am Heart J. 2013;166(5):806–814. PubMed CrossRef
- Kang B, Xu H, McConnell ES. Neurocognitive and psychiatric comorbidities of posttraumatic stress disorder among older veterans: a systematic review. Int J Geriatr Psychiatry. 2019;34(4):522–538. PubMed
- Davidson JR. Recognition and treatment of posttraumatic stress disorder. JAMA. 2001;286(5):584–588. PubMed CrossRef
- Kimerling R. An investigation of sex differences in nonpsychiatric morbidity associated with posttraumatic stress disorder. J Am Med Womens Assoc (1972). 2004;59(1):43–47. PubMed
- Peitl MV, Palaić D, Habibović F, et al. The incidence of comorbid mental and physical conditions in patients with post-traumatic stress disorder. Acta Clin Croat. 2022;61(2):295–302. PubMed
- Greene T, Neria Y, Gross R. Prevalence, detection and correlates of PTSD in the primary care setting: a systematic review. J Clin Psychol Med Settings. 2016;23(2):160–180. PubMed CrossRef
- Frayne SM, Chiu VY, Iqbal S, et al. Medical care needs of returning veterans with PTSD: their other burden. J Gen Intern Med. 2011;26(1):33–39. PubMed
- Vuagnat A, Jollant F, Abbar M, et al. Recurrence and mortality 1 year after hospital admission for non-fatal self-harm: a nationwide population-based study. Epidemiol Psychiatr Sci. 2019;29:e20. PubMed CrossRef
- Vaiva G, Berrouiguet S, Walter M, et al. Combining postcards, crisis cards, and telephone contact into a decision-making algorithm to reduce suicide reattempt: a randomized clinical trial of a personalized brief contact intervention. J Clin Psychiatry. 2018;79(6):17m11631. PubMed CrossRef
- Vaiva G, Walter M, Al Arab AS, et al. ALGOS: the development of a randomized controlled trial testing a case management algorithm designed to reduce suicide risk among suicide attempters. BMC Psychiatry. 2011;11(1):1. PubMed
- Vaiva G, Ducrocq F, Mathieu D. Systematic telephone contacting of patients leaving the Emergency Department after a suicide attempt: does it affect the one year outcome? BMJ. 2006;332(7552):1241–1245. PubMed
- Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(suppl 20):22–57;quiz 34–57. PubMed
- van Buuren S, Groothuis-Oudshoorn K. mice: multivariate imputation by chained equations in R. J Stat Softw. 2011;45(3):1–67.
- Haw C, Hawton K, Houston K, et al. Psychiatric and personality disorders in deliberate self-harm patients. Br J Psychiatry. 2001;178(1):48–54. PubMed
- Christiansen DM, Berke ET. Gender- and sex-based contributors to sex differences in PTSD. Curr Psychiatry Rep. 2020;22(4):19. PubMed
- LeBouthillier DM, McMillan KA, Thibodeau MA, et al. Types and number of traumas associated with suicidal ideation and suicide attempts in PTSD: findings from a U.S. Nationally representative sample. J Trauma Stress. 2015;28(3):183–190. PubMed CrossRef
- Tulloch AD, David AS, Thornicroft G. Exploring the predictors of early readmission to psychiatric hospital. Epidemiol Psychiatr Sci. 2015;25(2):181–193. PubMed CrossRef
- Callaly T, Trauer T, Hyland M, et al. An examination of risk factors for readmission to acute adult mental health services within 28 days of discharge in the Australian setting. Australas Psychiatry. 2011;19(3):221–225. PubMed
- Lorine K, Goenjian H, Kim S, et al. Risk factors associated with psychiatric readmission. J Nerv Ment Dis. 2015;203(6):425–430. PubMed CrossRef
- Mascayano F, Haselden M, Corbeil T, et al. Patient-hospital-and system-level factors associated with 30-day readmission after a psychiatric hospitalization. J Nerv Ment Dis. 2022;210(10):741–746. PubMed CrossRef
- Hawn SE, Hawrilenko M, McDowell Y, et al. An in-depth look at latent classes of DSM-5 psychiatric comorbidity among individuals with PTSD: clinical indicators and treatment utilization. J Clin Psychol. 2022;78(11):2214–2244. PubMed CrossRef
- Kartha A, Brower V, Saitz R, et al. The impact of trauma exposure and post traumatic stress disorder on healthcare utilization among primary care patients. Med Care. 2008;46(4):388–393. PubMed CrossRef
- Calhoun PS, Bosworth HB, Grambow SC, et al. Medical service utilization by veterans seeking help for posttraumatic stress disorder. Am J Psychiatry. 2002;159(12):2081–2086. PubMed CrossRef
- van den Berk-Clark C, Secrest S, Walls J, et al. Association between posttraumatic stress disorder and lack of exercise, poor diet, obesity and co occurring smoking: a systematic review and meta-analysis. Health Psychol. 2018;37(5):407–416. PubMed CrossRef
- Renna ME, O’Toole MS, Spaeth PE, et al. The association between anxiety, traumatic stress, and obsessive–compulsive disorders and chronic inflammation: a systematic review and meta-analysis. Depress Anxiety. 2018;35(11):1081–1094. PubMed CrossRef
Please sign in or purchase this PDF for $40.
Save
Cite
Already a member? Login