The Relationship Between PTSD & Suicide
A new report published by the Centers for Disease Control and Prevention shows suicide rates increased in 49 states between 1999 and 2016, with 45,000 suicide deaths in 2016. Since 2008, suicide has ranked as the 10th leading cause of death for all ages in the U.S. Alarmingly, suicide became the second leading cause of death among those aged 10-34 and the fourth leading cause among those aged 35-54. In the past, females may have attempted suicide more often than men, however, the rate of completed suicide in women is increasing.
Although suicide is often linked to mental illness, 54% of suicides in 2016 were not linked to a diagnosed mental health condition. Experts said statistics alone are misleading because in retrospect, about 90% of suicide victims actually had evidence of a mental health condition post mortem. This implies a large number of people are struggling with undiagnosed, untreated disorders that likely contributed to taking their own lives. Other issues linked to suicide include relationship problems, a recent crisis, problematic substance use, physical health problems, job/financial issues, criminal legal problems and loss of housing.
PTSD and Suicide
An estimated 7-8% of the general U.S. population have post-traumatic stress disorder (PTSD) at some point in their lives (10% females versus 4% males). Individuals with PTSD actively avoid triggering traumatic experiences and suffer chronic psychological distress, most notably intrusive flashback memories. Some studies suggest suicide risk is higher among those who experience trauma with symptoms of PTSD, while other research shows suicide risk is higher in these individuals because of related psychiatric conditions. Several studies have shown even after adjusting for comorbid mental and physical disorders, PTSD is a significant risk factor for suicide. Other contributing factors specific to an increased risk of suicide in veterans include:
- A history of military sexual trauma (MST)
- Being wounded multiple times and/or hospitalized for a wound
- Combat-related guilt
- High levels of intrusive memories
- Anger and impulsivity
Veteran Suicide Facts and Stats
The U.S. Department of Veterans Affairs published the most recent suicide data available in June 2018.
- In 2015, veterans comprised 8.3% of the U.S. adult population and 14.3% of all deaths by suicide among U.S. adults. This is a decrease from 2010, when veterans represented 9.6% of the U.S. adult population and 16.5% of all deaths by suicide.
- After adjusting for age differences, the rate of suicide in 2015 was 2.1 times higher among veterans versus non-veteran adults, with a higher comparative rate in females.
- In 2015, veteran suicide deaths involving firearms remained unchanged from 2014 at 67.0%.
- Veterans ages 55 and older accounted for 58.1% of all veteran suicide deaths in 2015, although they had the lowest suicide rate by age group.
- In 2015, an average of 20.6 active-duty Service members, non-activated Guard or Reserve members, and other veterans died by suicide each day, including 6.1 who recently used Veteran Health Administration Services.
A study published in the July 2018 issue of Psychiatry Research uncovered important insights on PTSD and other contributing suicide factors in veterans. The study evaluated 746 veterans at two U.S. Department of Veterans Affairs sites in the San Francisco Bay Area. While more than 50% of the veterans served in Vietnam, the study included those who served during World War II, the Korean War, the Gulf War, the Iraq War and the War in Afghanistan.
- Regardless of when they served, 50% of veterans with co-occurring PTSD and depression said in the previous two weeks they would be better off dead or hurting themselves.
- Suicidal and self-harm ideation occurred in 34% of veterans with depression alone, 11% with PTSD alone and only 2% with neither disorder.
- In those with PTSD and depression, anger, hostility, anxiety, alcohol use, optimism and social support did not contribute to the increased risk of suicidal ideation.
- The link between PTSD and depression is undetermined. PTSD could lead to depression which in turn could result in suicidal thoughts or depression may increase the risk of developing PTSD.
Higher Suicide Rates in Women
The suicide rate for female veterans has soared 85% in recent years. Female veterans are nearly 250% more likely to kill themselves than civilian women, while male veterans have an 18% increased risk compared to their civilian counterparts. Women may be pulled from the support networks in their own units and sent to locations where they witness heavy fighting. And they can’t let their guard down and decompress like men between missions due to the high incidence of sexual assault.
In 2010, Deana Martorella Orellana was deployed to a combat-torn region of Afghanistan, working with Afghan women and children. After she returned home in 2013, she stayed close to Camp Lejeune, tending bar and working as a personal trainer. Things started to fall apart after her rental home burned down, she moved out of her boyfriend’s house and she was charged twice with driving drunk. Although she agreed to seek counseling at the VA in March 2016, this never happened and she killed herself with a handgun from her boyfriend’s house while he was at work. This happened just a few months after her official military enlistment ended and a VA official later told her family Deana had PTSD related to combat and the house fire. An alarmingly high number of suicides occur in the first days, weeks and months after veterans leave the military.
PTSD Research in Non-Veterans
A large-scale Korean study analyzed contributing factors in adults exposed to trauma, those with PTSD and suicide ideation. Of 5,909 adults, 818 were included in the trauma-exposed healthy group (TEHC) and 76 were included in the PTSD group. The non-interpersonal trauma (NIT) group included warfare, life-threatening accident, natural disaster, witnessing serious accidents or death, other stressful accidents and indirect exposure to a stressful accident. The interpersonal trauma (IT) group included sexual assault, sexual harassment, physical assault, threatened assault with a weapon, incarceration as a prisoner of war/kidnapping and terrorism-related torture. A statistical analysis showed individuals with PTSD who experienced IT as the most traumatizing event were significantly younger and more likely to be female compared to those who experienced NIT. Key findings included:
- High agreeableness and conscientiousness scores predicted lower suicidality in the PTSD group.
- Individuals in the IT group were 3.643 times more likely to have suicidal ideation than the NIT group, yet the type of trauma did not predict any significant change in suicidal planning or attempts.
- Individuals in the NIT group with high agreeableness and conscientiousness scores were less likely to have attempted suicide, while those in the IT group with the same personality factors were more likely to have attempted suicide.
- Interpersonal trauma is a considerable risk factor for suicidality in those with PTSD.
A number of evidence-based treatments have been found to be helpful in reducing PTSD or trauma-related symptoms and decreasing suicidal ideation.
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