Veterans with PTSD at a Higher Risk of Suicide

Veterans who tested positive for posttraumatic stress disorder (PTSD) were associated with a 58% higher risk of suicide right after screening compared to vets without PTSD. One year later, vets with PTSD had a 26% higher risk. The strongest indicator was a “yes” answer to feeling “numb or detached from others, activities, or your surroundings.”

Veterans experience higher rates of both PTSD and suicide compared to the general population. This study links the two.

Researchers used the VHA Corporate Data Warehouse to identify more than 1.5 million people who completed Primary Care–Posttraumatic Stress Disorder (PC-PTSD) screens in 2014 who fit the criteria. Suicide mortality was measured one day after PTSD screen administration. The researchers also categorized the type of care patients received on the PTSD screen date: primary care, specialty mental health care, and inpatient mental health stay, among others.

Without adjusting for covariates, a positive PTSD screen was associated with a 90% increase in the risk of suicide mortality at 1 day after screening (hazard ratio [HR], 1.90; 95% CI, 1.44-2.52) compared with a negative result. The risk decreased throughout the 3-year follow up period. With adjusting for covariates, a positive PTSD screen was associated with a 58% increase in the risk of suicide mortality at 1 day after screening. Risk also decreased over time.

“In lieu of waiting for a formal diagnosis, it may be important to consider initiating suicide risk assessment strategies for patients with positive responses on the PC-PTSD,” the researchers said. “Another reason to use and incorporate the PC-PTSD into suicide risk assessment strategies is that, unlike a medical records diagnosis, the PC-PTSD asks a patient about PTSD symptoms experienced within the past month. The symptom severity of PTSD may fluctuate daily.”

Limitation include the fact that the data may not apply to other populations. Researchers may not have captured every PTSD screen administered within the VHA health system in 2014.

Disclosures: One of the study authors reported receiving grants from the US Department of Veterans Affairs Health Services Research and Development Service during the conduct of the study. Another reported receiving grants from the US Department of Veterans Affairs Health Services Research and Development Service outside the submitted work. No other disclosures were reported.

Reference

Cooper SA, Szymanski BR, Bohnert KM, Sripada RK, McCarthy JF. Association between positive results on the primary care-posttraumatic stress disorder screen and suicide mortality among US veterans. JAMA Netw Open. 2020 Sep 1;3(9):e2015707. doi: 10.1001/jamanetworkopen.2020.15707.