{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T07:53:48Z","timestamp":1790063628026,"version":"4.0.1"},"reference-count":30,"publisher":"Royal College of Psychiatrists","issue":"5","license":[{"start":{"date-parts":[[2022,8,23]],"date-time":"2022-08-23T00:00:00Z","timestamp":1661212800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH121397"],"award-info":[{"award-number":["R01MH121397"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Psychiatry"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:sec id=\"S0007125022001106_sec_a1\"><jats:title>Background<\/jats:title><jats:p>There is mixed evidence regarding the direction of a potential association between post-traumatic stress disorder (PTSD) and suicide mortality.<\/jats:p><\/jats:sec><jats:sec id=\"S0007125022001106_sec_a2\"><jats:title>Aims<\/jats:title><jats:p>This is the first population-based study to account for both PTSD diagnosis and PTSD symptom severity simultaneously in the examination of suicide mortality.<\/jats:p><\/jats:sec><jats:sec id=\"S0007125022001106_sec_a3\" sec-type=\"methods\"><jats:title>Method<\/jats:title><jats:p>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 (<jats:italic>n<\/jats:italic>= 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.<\/jats:p><\/jats:sec><jats:sec id=\"S0007125022001106_sec_a4\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Any level of PTSD symptoms above the minimum threshold for symptomatic remission (i.e. PCL score &gt;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\u20130.88).<\/jats:p><\/jats:sec><jats:sec id=\"S0007125022001106_sec_a5\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>Ameliorating PTSD can reduce risk of suicide mortality, but patients must achieve symptomatic remission to attain this benefit.<\/jats:p><\/jats:sec>","DOI":"10.1192\/bjp.2022.110","type":"journal-article","created":{"date-parts":[[2022,8,23]],"date-time":"2022-08-23T11:18:52Z","timestamp":1661253532000},"page":"676-682","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":17,"title":["Association between post-traumatic stress disorder severity and death by suicide in US military veterans: retrospective cohort study"],"prefix":"10.1192","volume":"221","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8618-8205","authenticated-orcid":false,"given":"Jenna A.","family":"Forehand","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Dufort","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1459-5327","authenticated-orcid":false,"given":"Jaimie L.","family":"Gradus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shira","family":"Maguen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2397-6359","authenticated-orcid":false,"given":"Bradley V.","family":"Watts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6887-5706","authenticated-orcid":false,"given":"Tammy","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5440-3698","authenticated-orcid":false,"given":"Nicholas","family":"Holder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Shiner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2022,8,23]]},"reference":[{"key":"S0007125022001106_ref21","doi-asserted-by":"publisher","DOI":"10.1111\/jep.13587"},{"key":"S0007125022001106_ref22","unstructured":"22 Weathers, FW , Litz, BT , Herman, DS , Huska, JA , Keane, T The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. International Society for Traumatic Stress Studies, 9th Annual Meeting \u2018Trauma, Coping, and Adaptation\u2019 (San Antonio, Texas, October 24\u201327, 1993). ISTSS, 1993."},{"key":"S0007125022001106_ref18","doi-asserted-by":"publisher","DOI":"10.1002\/jts.22689"},{"key":"S0007125022001106_ref9","first-page":"1","article-title":"PTSD and death from suicide","volume":"28","author":"Gradus","year":"2017","journal-title":"Natl Cent PTSD: PTSD Res Quart"},{"key":"S0007125022001106_ref19","unstructured":"19 Center of Excellence for Suicide Prevention. Joint Department of Veterans Affairs (VA) and Department of Defense (DoD) Mortality Data Repository \u2013 National Death Index (NDI). VA\/DoD Board of Governance, 2021 (https:\/\/www.mirecc.va.gov\/suicideprevention\/documents\/VA_DoD-MDR_Flyer-92421.pdf)."},{"key":"S0007125022001106_ref7","unstructured":"7 National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-term Trends in Health. Centres for Diseases Control and Prevention, 2021 (https:\/\/www.cdc.gov\/nchs\/data\/hus\/hus16.pdf)."},{"key":"S0007125022001106_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2012.02.009"},{"key":"S0007125022001106_ref4","unstructured":"4 Office of Mental Health and Suicide Prevention. 2019 National Veteran Suicide Prevention Annual Report. US Dept of Veterans Affairs. 2019."},{"key":"S0007125022001106_ref13","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-017-1377-x"},{"key":"S0007125022001106_ref23","doi-asserted-by":"publisher","DOI":"10.1002\/jts.22438"},{"key":"S0007125022001106_ref1","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","year":"2013"},{"key":"S0007125022001106_ref11","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1001\/archgenpsychiatry.2010.129","article-title":"Psychiatric diagnoses and risk of suicide in veterans","volume":"67","author":"Ilgen","year":"2010","journal-title":"Arch Gen Psychiatry"},{"key":"S0007125022001106_ref10","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1097\/00005053-199411000-00002","article-title":"Posttraumatic stress disorder and the risk of traumatic deaths among Vietnam veterans","volume":"182","author":"Bullman","year":"1994","journal-title":"J Nerv Ment Dis"},{"key":"S0007125022001106_ref15","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.15707"},{"key":"S0007125022001106_ref12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jad.2014.04.067","article-title":"Posttraumatic stress disorder and suicide in 5.9 million individuals receiving care in the veterans health administration health system","volume":"166","author":"Conner","year":"2014","journal-title":"J Affect Disord"},{"key":"S0007125022001106_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2020.103756"},{"key":"S0007125022001106_ref3","unstructured":"3 Greenberg, G , Hoff, R . Veterans with PTSD Data Sheet: National, VISN, and VAMC Tables. Northeast Program Evaluation Center. 2016."},{"key":"S0007125022001106_ref29","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data","volume":"43","author":"Quan","year":"2005","journal-title":"Med Care"},{"key":"S0007125022001106_ref5","doi-asserted-by":"publisher","DOI":"10.1080\/13811110903478997"},{"key":"S0007125022001106_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2014.11.017"},{"key":"S0007125022001106_ref28","doi-asserted-by":"publisher","DOI":"10.1007\/s10865-020-00176-9"},{"key":"S0007125022001106_ref26","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1037\/pas0001098","article-title":"Reliable and clinically significant change in the clinician-administered PTSD Scale for DSM-5 and PTSD Checklist for DSM-5 among male veterans","volume":"34","author":"Marx","year":"2021","journal-title":"Psychol Assess"},{"key":"S0007125022001106_ref30","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.21.3252"},{"key":"S0007125022001106_ref16","doi-asserted-by":"crossref","unstructured":"16 Prins, A , Bovin, MJ , Kimerling, R , Kaloupek, DG , Marx, BP , Pless Kaiser, A , The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). National Center for PTSD, 2015.","DOI":"10.1037\/t92032-000"},{"key":"S0007125022001106_ref17","doi-asserted-by":"publisher","DOI":"10.1037\/pas0000254"},{"key":"S0007125022001106_ref25","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.21m13913"},{"key":"S0007125022001106_ref2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwv066"},{"key":"S0007125022001106_ref6","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2015.302737"},{"key":"S0007125022001106_ref14","doi-asserted-by":"publisher","DOI":"10.1111\/sltb.12482"},{"key":"S0007125022001106_ref27","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1037\/0022-006X.59.1.12","article-title":"Clinical significance: a statistical approach to defining meaningful change in psychotherapy research","volume":"59","author":"Jacobson","year":"1991","journal-title":"J Consult Clin Psychol"}],"container-title":["The British Journal of Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0007125022001106","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,2]],"date-time":"2024-10-02T09:49:25Z","timestamp":1727862565000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0007125022001106\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,23]]},"references-count":30,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,11]]}},"alternative-id":["S0007125022001106"],"URL":"https:\/\/doi.org\/10.1192\/bjp.2022.110","relation":{},"ISSN":["0007-1250","1472-1465"],"issn-type":[{"value":"0007-1250","type":"print"},{"value":"1472-1465","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,23]]},"assertion":[{"value":"Copyright \u00a9 The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}