Abstract
Background
There appears to be a strong connection between suicidality and the experience of trauma. The study investigated suicidality in chronic civilian post–traumatic stress disorder (PTSD).
Method
Ninety–four participants suffering from chronic PTSD were assessed for suicidal ideation, plans and attempts since the index trauma as part of a comprehensive assessment. The prevalence of these was assessed and characteristics of those reporting suicide–related thoughts and behaviour were investigated through logistic and multinominal regression analyses.
Results
Over half of the sample (56.4%) reported some aspect of suicidality with 38.3% reporting ideation, 8.5% reporting suicide plans and 9.6% having made suicide attempts since the trauma. Of the nine participants who reported suicide attempts, six had made more than one attempt. The proportions of participants who reported suicidality in this sample were significantly greater than reported within the general population, when comparisons were made with an epidemiological study. Logistic regression analysis indicated that a unit increase in life impairment (OR = 3.1) and depression (OR = 1.14) scores were independently and significantly associated with suicidality. Multinominal regression indicated that life impairment (OR = 2.71) and depression (OR = 1.13) scores were associated with the presence of suicidal ideation compared to no ideation, and life impairment (OR = 5.75), depression (OR = 1.2) scores and receiving psychotropic medication (OR = 10.6) were associated with the presence of plans and attempts compared to no suicidal behaviour.
Conclusions
Suicide risk is elevated in those suffering from chronic PTSD and is associated with impaired functioning in combination with depression.
Similar content being viewed by others
References
Adams DP, Barton C, Mitchell GL, Moore AL, Einagel V (1998) Hearts and minds: suicide among United States combat troops in Vietnam. Soc Sci Med 47:1687–1694
Allgulander C (2000) Psychiatric aspects of suicidal behaviour: Anxiety disorders. In: Hawton K, van Heeringen K (eds) The International Handbook of Suicide and Attempted Suicide. Chichester: Wiley, p 179–192
Anderson BA, Howard MO, Walker RD, Suchinsky RT (1995) Characteristics of substance-abusing veterans attempting suicide: a national study. Psychol Rep 77:1231–1242
Beck AT (1988) Beck depression inventory. New York: The Psychological Corporation
Beck AT (1990) Beck anxiety inventory. New York: The Psychological Corporation
Blake D, Weathers F, Nogy F, KaloupekD, Klauminzer G, Charney D, Keane T (1990) A clinician rating scale for assessing current and lifetime PTSD: the CAPS-1. The Behavior Therapist, pp 187–188
Davidson JRT, Hughes DC, Blazer DG, George LK (1991) Posttraumatic stress disorder in the community: an epidemiological study. Psychol Med 21:713–721
Davidson JRT, Hughes DC, George LK, Blazer DG (1996) The association of sexual assault and attempted suicide within the community. Arch Gen Psychiatry 53:550–555
Dube SR, Anda RF, Felitti VJ, Chapman DP, Williamson DF, Giles W (2001) Childhood abuse, household dysfunction and the risk of attempted suicide throughout the life span: findings from the adverse childhood experiences study. J Am Med Assoc 286:3089–3096
Farberow NL, Kang HK, Bullman TA (1990) Combat experience and postservice psychosocial status as predictors of suicide in Vietnam veterans. J Nerv Ment Dis 178:32–37
Fawcett J, Busch KA, Jacobs D, Kravitz HM, Fogg L (1998) Suicide: a four-pathway clinical-biochemical model. Ann N Y Acad Sci 836:288–301
Fontana A, Rosenheck RA (1995) An etiological model of attempted suicide among Vietnam theatre veterans: prospective generalization to a treatment-seeking sample. J Nerv Mental Dis 183:377–383
Freeman TW, Keesee N, Thornton C, Gillette GM, Young K (1995) Dissociative symptoms in posttraumatic stress disorder subjects and a history of suicide attempts. J Nerv Ment Dis 183:664–666
Goldberg D, Williams P (1988) A user’s guide to the General Health Questionnaire. Windsor, Berks: NFER-Nelson
Gould DA, Stevens NG, Ward NG, Carlin AS, Sowell HE, Gustafson B (1994) Self-reported childhood abuse in an adult population in a primary care setting: prevalence, correlates, and associated suicide attempts. Arch Fam Med 3:252–256
Hammarberg M (1992) Penn Inventory for posttraumatic stress disorder: psychometric properties. Psychol Assess 4:67–76
Hendin H, Haas AP (1991) Suicide and guilt as manifestations of PTSD in Vietnam combat veterans. Am J Psychiatry 148:586–591
Horowitz MJ, Wilner N, Alvarez W (1979) Impact of events scale: A measure of subjective stress. Psychosom Med 41:209–218
Johnsson-Fridell E, Ojehagen A, Traskman-Bendz L (1996) A 5-year follow-up study of suicide attempts. Acta Psychiatr Scand 93:151–157
Kessler RC, Borges G, Walters EE (1999) Prevalence of and risk factors for lifetime suicide attempts in the national comorbidity survey. Arch Gen Psychiatry 56:617–626
Kotler M, Iancu I, Efroni R, Amir M (2001) Anger, impulsivity, social support and suicide risk in patients with posttraumatic stress disorder. J Nerv Ment Dis 189:162–167
Meltzer H, Gill B, Petticrew M, Hinds K (1995) Adults with suicidal thoughts (Chapter 6). Physical complaint, service use and treatment of adults with psychiatric disorders. OPCS Surveys of Psychiatric Morbidity in Great Britain. Report 2. London: HMSO
Moscicki EK, O’Carroll P, Rae DS, Locke BZ, Roy A, Regier DA (1988) Suicide attempts in the Epidemiological Catchment Area Study. Yale J Biol Med 61:259–268
Nordstrom P, Samuelsson M, Asberg M (1995) Survival analysis of suicide risk after attempted suicide. Acta Psychiatr Scand 91:336–340
Paykel ES, Myers JK, Lindenthal JJ, Tanner J (1974) Suicidal feelings in the general population: a prevalence study. Br J Psychiatry 124:460–469
Spitzer RL, Williams JB, Gibbon M (1987) Structured Clinical Interview for DSM IIIR. New York: New York State Psychiatric Institution, Biometrics Research Department
Steketee G, Foa EB (1987) Rape victims: post-traumatic stress responses and their treatment: a review of the literature. J Anxiety Disord 1:69–86
Tarrier N, Pilgrim H, Sommerfield C, Faragher B, Reynolds M, Graham EA, Barrowclough C (1999) A randomised controlled trial of cognitive therapy and imaginal exposure in the treatment of chronic post traumatic stress disorder. J Consult Clin Psychol 67:13–18
Tarrier N, Sommerfield C, Pilgrim H, Humphreys L (1999) Twelve month follow-up of a trial of cognitive therapy or imaginal exposure in the treatment of PTSD. Br J Psychiatry 175:571–575
Tarrier N, Sommerfield C, Pilgrim H, Faragher B (2000) Factors associated with outcome of cognitive-behavioural treatment of chronic stress disorder. Behav Res Ther 38:191–202
Thompson MP, Kaslow NJ, Kingree JB, Puett R, Thompson N, Meadows LA (1999) Partner abuse and posttraumatic stress disorder as a risk factor for suicide attempts in a sample of low-income, inner-city women. J Traum Stress 12:59–72
van Heeringen K (2001) The suicidal process and related concepts. In: van Heeringen K (ed) Understanding suicidal behaviour: the suicidal process approach to research, treatment and prevention. Chichester: Wiley
Weissman MM, Gerald LK, Markowitz JS, Ouellette R (1989) Suicidal ideation and suicide attempts in panic disorder and attacks. N Engl J Med 321:1209–1214
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tarrier, N., Gregg, L. Suicide risk in civilian PTSD patients. Soc Psychiatry Psychiatr Epidemiol 39, 655–661 (2004). https://doi.org/10.1007/s00127-004-0799-4
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00127-004-0799-4