PTSD Symptoms Double Suicide Mortality Rate in Veterans

Posttraumatic stress disorder (PTSD) was associated with double the suicide mortality rate for US veterans whose symptoms were not in remission, according to findings published in the British Journal of Psychiatry.

“There is mixed evidence regarding the direction of a potential association between [PTSD] and suicide mortality,” researchers said. “This is the first population-based study to account for both PTSD diagnosis and PTSD symptom severity simultaneously in the examination of suicide mortality.”

The retrospective cohort study involved 754,197 veterans treated at VA hospitals from October 1999 through December 2018. Patients were included if they were diagnosed with PTSD and had their symptoms assessed with the PTSD Checklist (PCL) at least once during the study period. Data on suicide mortality was collected from the VA/Department of Defense Mortality Data Repository.

PTSD symptom severity levels were used in multivariable proportional hazards regression models to estimate suicide mortality rates. For veterans whose symptoms were assessed more than once, researchers used the level of change in symptom severity to make additional models estimating suicide mortality rates over time.

“Any level of PTSD symptoms above the minimum threshold for symptomatic remission (ie PCL score >18) was associated with double the suicide mortality rate at 1 month after assessment,” investigators found.

Although this relationship decreased over time, elevated suicide mortality rates persisted for veterans who had moderate to severe symptoms. Additionally, the long-term suicide mortality rate was 25% higher for veterans whose PTSD symptoms worsened.

Among veterans whose PTSD improved, only those who achieved symptomatic remission experienced a substantial, sustained reduction in suicide mortality rate (HR = 0.56; 95% CI 0.37-0.88).

“Ameliorating PTSD can reduce risk of suicide mortality, but patients must achieve symptomatic remission to attain this benefit,” researchers concluded.

Reference:
Forehand JA, Dufort V, Gradus JL, et al. Association between post-traumatic stress disorder severity and death by suicide in US military veterans: Retrospective cohort study. Br J Psychiatry. 2022;1-7. doi:10.1192/bjp.2022.110