This fact sheet explores the relation between PTSD and suicide
and provides information about understanding and dealing with
suicide. This fact sheet is not intended to replace mental health
assistance obtained from a professional.
Does PTSD increase an individual's suicide risk?
A large body of research indicates that there is a correlation
between PTSD and suicide. There is evidence that traumatic events
such as sexual abuse, combat trauma, rape, and domestic violence
generally increase a person's suicide risk. Considerable
debate exists, however, about the reason for this increase.
Whereas some studies suggest that suicide risk is higher due to
the symptoms of PTSD,
1,2,3 others claim that suicide risk is higher in
these individuals because of related psychiatric conditions
4,5. Some studies that point to PTSD as the cause of
suicide suggest that high levels of intrusive memories can
predict the relative risk of suicide
1. High levels of arousal symptoms and low levels of
avoidance have also been shown to predict suicide risk
2,6. In contrast, other researchers have found that
conditions that co-occur with PTSD, such as depression, may be
more predictive of suicide
4. Further, some cognitive styles of coping such as
using suppression to deal with stress may be additionally
predictive of suicide risk in individuals with PTSD
1.
Given the high rate of PTSD in veterans, considerable research
has examined the relation between PTSD and suicide in this
population. Multiple factors contribute to suicide risk in
veterans, such as:
Male gender
Alcohol abuse
Family history of suicide
Older age
Poor social-environment support (exemplified by
homelessness and unmarried status)
Possession of firearms
The presence of medical and psychiatric
conditions (including combat-related PTSD) associated with
suicide
Currently there is debate about the exact influence of
combat-related trauma on suicide risk. For those veterans who
have PTSD as a result of combat trauma, however, it appears that
the highest relative suicide risk is observed in veterans who
were wounded multiple times and/or hospitalized for a wound
7. This suggests that the intensity of the combat
trauma, and the number of times it occurred, may influence
suicide risk in veterans with PTSD. Other research on veterans
with combat-related PTSD suggests that the most significant
predictor of both suicide attempts and preoccupation with suicide
is combat-related guilt8. Many veterans experience highly
intrusive thoughts and extreme guilt about acts committed during
times of war. These thoughts can often overpower the emotional
coping capacities of veterans.
Reasons for suicide
Individuals who have lost someone to suicide often question
why that person chose to end his/her life. Unfortunately, there
is no easy answer to this question. Suicide often appears to be
related to environmental stresses or traumatic events, but it is
also the case that some individuals commit suicide without any
identifiable reason. Though there is always devastation and
confusion associated with suicide, available research provides
some clues about common reasons for suicide.
Specific reasons for suicide are as diverse as the individuals
who commit it. Nevertheless, there are some common causal factors
that appear to be related to suicide. For example, more than 90%
of suicide victims have a significant psychiatric illness at the
time of their death9. These illnesses are often both undiagnosed
and untreated. The two most common psychiatric conditions
associated with suicide are mood disorders and substance abuse
10,11,12,13. When an individual has both a mood
disorder and a substance abuse issue, the risk of suicide is much
higher. This is especially the case for adolescents and young
adults
11,13. This research suggests that the presence of
mental illness is a primary contributor to the cause of suicide.
For individuals who suffer from clinical depression specifically,
of utmost concern are those who exhibit open aggression, anxiety,
or agitation, as these factors significantly increase the risk of
suicide.
14,15,16
Some researchers suggest that suicide can be understood as a
form of coping mechanism for individuals who feel overwhelmed and
trapped by their situation. For these people, suicide is seen as
a way of dealing with extremely strong negative emotions through
escape. This conceptualization of suicide is exemplified by the
relation between suicide rates and media coverage, particularly
in the young
9. Research reveals that the magnitude of increase in
suicides following a suicide story is proportional to the amount,
duration, and prominence of media coverage17. These data suggest
that suicide is more likely to occur when it is no longer
perceived as 'taboo' and instead is seen as a viable
coping alternative to stress. This hypothesis of suicide as a
coping alternative is further supported by evidence that a family
history of suicide greatly increases an individual's suicide
risk regardless of the presence of mental illness.18,19
What to do when someone is suicidal
When someone discloses information about feeling suicidal, the
information can feel overwhelming, anxiety-provoking, and
frightening. This is particularly true if the disclosure is made
in confidence and you feel pressure not to share the information
with others. If someone is thinking about suicide, the issue
should be taken very seriously. Individuals who contemplate
suicide may not necessarily take action, but evaluating the risk
can be complicated and should be done by a qualified mental
health professional.
Helping a suicidal individual can be a difficult process. The
person's age will influence your first course of action. If
the person is an adult, try to be supportive and listen to
his/her concerns. Next, encourage him/her to seek treatment
immediately. Help the person with this process by remaining calm
and providing information about mental health options in the
area.
Often the most difficult part of obtaining treatment is the
initial call to a mental health professional. It is usually
easier for a suicidal individual to accept professional help if
they have assistance with this part of the process. The decision
to seek treatment is typically voluntary for adults. Their
ability to maintain safety will determine the treatment
options.
Treatment options include outpatient therapy, medication
management, and/or inpatient treatment. Inpatient hospital visits
are typically only prescribed when an individual is no longer
safe without supervision. Sometimes involuntary hospital
admission is necessary. However, because of federal laws
protecting adult civil rights, this course of action in
uncommon. Involuntary admission only occurs when an
individual demonstrates unsafe behavior. If you feel that
the person may hurt him/herself or others, contact your local
police department for assistance.
If the person with suicidal thoughts is a minor (under the age
of 18), it is important to contact the minor's parent or
legal guardian. If the caregiver is unwilling or unable to
take action, contact a mental health professional or law
enforcement agent for assistance. The law sates that
individuals under the age of 18 are not able to make mental
health treatment decisions. Therefore, it is important that
responsible adults see that they receive the appropriate
services. Treatment options for children and adolescents
are similar to those outlined for adults. Unlike adults,
however, minors may receive inpatient hospitalization without
their consent if it is deemed necessary by their parents or the
legal system.
While helping a suicidal person can be a difficult process,
remember that the assistance you provide could save
someone's life. If you think someone may be suicidal, you
should directly ask him or her. You will NOT be putting the idea
in their head.
Suicide as a traumatic event
A considerable amount of research examines exposure to suicide
as a traumatic event. Studies show that trauma from exposure to
suicide can contribute to PTSD. In particular, adults and
adolescents are more likely to develop PTSD as a result of
exposure to suicide if one or more of the following conditions
are true: if they witness the suicide, if they are very connected
with the person who dies, or if they have a history of
psychiatric illness.20,21,22 However, relative to other traumatic
events, there appears to be nothing unique about developing PTSD
as a consequence of exposure to suicide.23,24 Studies do show,
however, that Òtraumatic griefÓ is more likely to arise
after exposure to traumatic death such as suicide25. Traumatic
grief refers to a syndrome in which individuals experience
functional impairment, a decline in physical health, and suicidal
ideation. These symptoms occur independent of other conditions
such as depression and anxiety
26.
References:
1. Amir, M., Kaplan, Z., Efroni, R., & Kotler, M. (1999).
Suicide risk and coping styles in posttraumatic stress disorder
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2. Ben-Yaacov, Y., & Amir, M. (2004).
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Individual Differences, 36, 1257-1264.
3. Thompson, M. E., Kaslow, N. J., Kingree, J. B.,
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