Posttraumatic stress disorder (PTSD) is a well-established risk factor for suicidal thoughts and behaviors. Historically, guidelines for treating PTSD have recommended against the use of trauma-focused therapies with patients who are high-risk for suicide likely due to concerns about potential suicide-related iatrogenesis, specifically the "triggering" of suicidal behaviors. This systematic review examines evidence for the impact of treatments specifically designed to treat PTSD or suicide on both PTSD-and suicide-related outcomes. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and a total of 33 articles met full inclusion criteria, of which 23 examined PTSD treatments, 4 examined suicidefocused treatments, and 6 examined combined treatments. PTSD and combined treatments reduced both PTSD-and suicide-related outcomes, with most studies examining Cognitive Processing Therapy or Prolonged Exposure. Suicide-focused treatments (e.g., cognitive therapies for suicide prevention) also reduced suicide-related outcomes, but findings were mixed for their impact on PTSD-related outcomes. Overall, PTSD treatments had the most support, primarily due to a larger number of studies examining their outcomes. This supports current clinical guidelines, which suggest utilizing PTSD treatments for individuals at risk for suicide and who have PTSD. Suicide-focused and combined treatments also appeared to be promising formats although additional research is needed. Future research should seek to compare the effectiveness

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Posttraumatic stress disorder (PTSD) is a well-established risk factor for suicidal thoughts and behaviors. Historically, guidelines for treating PTSD have recommended against the use of trauma-focused therapies with patients who are high-risk for suicide likely due to concerns about potential suicide-related iatrogenesis, specifically the “triggering” of suicidal behaviors. This systematic review examines evidence for the impact of treatments specifically designed to treat PTSD or suicide on both PTSD- and suicide-related outcomes. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and a total of 33 articles met full inclusion criteria, of which 23 examined PTSD treatments, 4 examined suicide-focused treatments, and 6 examined combined treatments. PTSD and combined treatments reduced both PTSD- and suicide-related outcomes, with most studies examining Cognitive Processing Therapy or Prolonged Exposure. Suicide-focused treatments (e.g., cognitive therapies for suicide prevention) also reduced suicide-related outcomes, but findings were mixed for their impact on PTSD-related outcomes. Overall, PTSD treatments had the most support, primarily due to a larger number of studies examining their outcomes. This supports current clinical guidelines, which suggest utilizing PTSD treatments for individuals at risk for suicide and who have PTSD. Suicide-focused and combined treatments also appeared to be promising formats although additional research is needed. Future research should seek to compare the effectiveness of the approaches to the treatment of PTSD and suicidal thoughts and behaviors concurrently, as well as to inform guidelines aimed at supporting decisions about the selection of an appropriate treatment approach.

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Suicide is a leading cause of death in the United States. About 9 percent of adults will experience serious suicide ideation in their lifetimes, but many fewer will go on to make a suicide attempt or die by suicide. Therefore, identification of who is likely to transition from suicidal thoughts to actions is imperative to preventing suicide deaths. Traumatic experiences and posttraumatic stress disorder (PTSD) are two of a limited number of risk factors that differentiate suicide ideators from suicide attempters. Further, certain types of trauma and groups of people are at increased risk for suicidal thoughts and actions. For example, childhood trauma and maltreatment, as well as history of sexual assault, are both associated with unique risk for suicidal thoughts and behaviors after controlling for various additional risk factors and PTSD symptom severity. Additionally, military personnel/veterans and lesbian, gay, transgender, and bisexual individuals are two high-risk populations for death by suicide. Several theories of how traumatic experiences confer increased risk for suicidal thoughts and behaviors, as well as theories within the ideation-to-action framework (which explain transition from suicidal thoughts to behaviors), are presented and discussed to increase understanding of this phenomenon, as well as possible targets of intervention.