Major Findings: Suicidality and PTSD numbing symptoms were independently associated.
Data Source: Psychiatric diagnoses and suicidality were assessed in 393 military veterans formerly deployed to a region of conflict.
Disclosures: None reported.
ATLANTA — Assessment of suicidality might be warranted when treating recent combat veterans with posttraumatic stress disorder, according to a study.
PTSD, major depressive disorder (MDD), and a history of one or more suicide attempts each independently predicted increased risk of suicidality among 393 veterans of Operation Enduring Freedom or Operation Iraqi Freedom after their return to the United States.
Of note, PTSD predicted increased risk for suicidality even in the absence of well-known psychiatric comorbidity risk factors, Vito S. Guerra, Ph.D., said at the annual meeting of the International Society for Trauma Stress Studies.
“For someone with PTSD, even without alcohol use disorder or major depressive disorder, [there are] data that they are at risk for self-harm,” Dr. Guerra said in an interview at his poster.
Previous research showed a significantly increased risk for suicidality among veterans of the Vietnam War with PTSD (Mil. Med. 2007;172:1144-7). To assess the risks in more recent combat veterans, Dr. Guerra and his colleagues studied 322 men and 71 women deployed to Afghanistan or Iraq. Mean age of participants was 38 years.
Psychiatric diagnoses and suicidality were assessed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I); the Beck Depression Inventory–Second Edition; the Davidson Trauma Scale; the Combat Exposure Scale; and the Beck Scale for Suicide Ideation (BSS)/Scale for Suicide Ideation–Adapted (SSI-A).
A total of 143 (36%) veterans met SCID-I criteria for PTSD. The emotional numbing cluster of PTSD symptoms, measured on the Davidson Trauma Scale, was independently associated with suicidality within this subgroup (adjusted odds ratio 3.8).
Suicidality was defined as a combined score of three or more on the BSS and SSI-A measures, said Dr. Guerra, a postdoctoral psychology fellow at the VA Mid-Atlantic Mental Illness Research, Education and Clinical Center in Durham, N.C.
Major depression and alcohol use disorder (AUD) were less common than PTSD: 88 (22%) of veterans met MDD criteria and 17 (4%) met AUD criteria.
The researchers also looked at comorbidity: 66 (17%) participants met criteria for both PTSD and MDD and 11 (3%) veterans were comorbid with PTSD and AUD. However, presence of either comorbidity did not significantly elevate the risk for suicidality, compared with PTSD alone, Dr. Guerra said.
In contrast, there are data suggesting that people dually diagnosed with PTSD and MDD might be at greater risk of engaging in suicidal acts than persons diagnosed with MDD only, Dr. Guerra said (Am. J. Psychiatry 2005;162:560-6; Am. J. Psychiatry 2001;158:1467-73).
The cognitive-affective cluster of depressive symptoms, such as persistent depressed mood or excessive/inappropriate guilt, was positively associated with increased suicidality among PTSD-diagnosed participants.