Trauma Burden and Suicidality in PTSD

Although suicidal ideation and suicide attempts have long been associated with post-traumatic stress disorder (PTSD), few large population-based studies have examined how different types of traumatic events or the total number of traumatic events might affect suicidality. Using data from a U.S. representative sample of 34,653 adults, investigators sought to uncover relationships among traumatic events, PTSD diagnosis, self-reported suicidal ideation during one's lifetime, and suicide attempt after traumatic events.

Twenty-seven types of traumatic events occurring from childhood through adulthood were examined, including civilian and military traumas. Of participants who qualified for PTSD diagnoses, 783 (31.9%) reported lifetime suicidal ideation and 340 (13.6%) reported a post-trauma attempt (no-trauma group: lifetime suicidal ideation, 5.4%; attempt, 0.9%). Rates of suicidal ideation and attempts varied by trauma type. For example, frequency of suicidal ideation ranged from 8.3% (for “refugee”) to 51.9% (for serious neglect or physical maltreatment before age 18 by parent/caretaker); similarly, suicide attempt frequency ranged from 1.6% (for “refugee” or seeing someone close die in terrorist attack) to 36.9% (for physical maltreatment before age 18 by parent/caretaker). Maltreatment in childhood; physical assault; and being kidnapped, a hostage, or a peacekeeper in war were individually associated with the highest rates of suicidal ideation and attempts. Rates of suicidal ideation and attempts showed linear relationships to numbers of traumatic events:

• Ideation: 1–2 events, 15.6%; ≥10 events, 51.4%

• Attempts: 1–2 events, 3.3%; ≥10 events, 36.9%