Association between post-traumatic stress disorder severity and death by suicide in US military veterans: retrospective cohort study

Abstract

Background There is mixed evidence regarding the direction of a potential association between post-traumatic stress disorder (PTSD) and suicide mortality. Aims This is the first population-based study to account for both PTSD diagnosis and PTSD symptom severity simultaneously in the examination of suicide mortality. Method Retrospective study that included all US Department of Veterans Affairs (VA) patients with a PTSD diagnosis and at least one symptom severity assessment using the PTSD Checklist (PCL) between 1 October 1999 and 31 December 2018 (n = 754 197). We performed multivariable proportional hazards regression models using exposure groups defined by level of PTSD symptom severity to estimate suicide mortality rates. For patients with multiple PCL scores, we performed additional models using exposure groups defined by level of change in PTSD symptom severity. We assessed suicide mortality using the VA/Department of Defense Mortality Data Repository. Results Any level of PTSD symptoms above the minimum threshold for symptomatic remission (i.e. PCL score >18) was associated with double the suicide mortality rate at 1 month after assessment. This relationship decreased over time but patients with moderate to high symptoms continued to have elevated suicide rates. Worsening PTSD symptoms were associated with a 25% higher long-term suicide mortality rate. Among patients with improved PTSD symptoms, those with symptomatic remission had a substantial and sustained reduction in the suicide rate compared with those without symptomatic remission (HR = 0.56; 95% CI 0.37–0.88). Conclusions Ameliorating PTSD can reduce risk of suicide mortality, but patients must achieve symptomatic remission to attain this benefit.

Alcohol use disorder as a moderator of the relationship between posttraumatic stress disorder and suicidality among military personnel

“…Frequent exposure to potentially traumatic events and a culture of alcohol consumption have made posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) common among service members, estimated to affect 3.9%–10.5% and 26.1%–48.6%, respectively, depending on branch of service (Schuler et al., 2022). Both disorders increase the likelihood of suicidal behavior (Forehand et al., 2022; Hill et al., 2021).…”

Development and feasibility pilot of Considering PTSD Treatment: An online intervention with peer support

“…For instance, women veterans in that sample were almost three times more likely to meet criteria for PTSD than men (11 % and 4 %, respectively), and prevalence was highest (14 %) among combat veterans of the wars in Iraq and Afghanistan ( Na et al, 2023 ). PTSD is associated with high rates of psychiatric comorbidity, increased suicide risk, and deficits in social/occupational and physical functioning ( Ahmadian et al, 2019 ; Forehand et al, 2022 ; Vogt et al, 2017 ; Walter et al, 2018 ). Despite high levels of distress and impairment, rates of treatment seeking are surprisingly low among both civilians and veterans with PTSD.…”