Posttraumatic stress disorder (PTSD) — but not exposure to traumatic events without the development of PTSD — may be associated with subsequent attempted suicide in young adults, according to a report in the March issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Approximately 421,200 to 842,400 Americans age 15 to 24 attempt suicide every year, according to background information in the article. "History of a suicide attempt has been identified as one of the best predictors of a future attempt as well as completed suicide," the authors write. Suicide was the third leading cause of death among U.S. young people in 2005.
Holly C. Wilcox, Ph.D., of Johns Hopkins Children's Center, Baltimore, and colleagues studied 1,698 young adults of a group of 2,311 who had been tracked since entering the first grade in Baltimore public schools. Fifteen years later, 90-minute interviews were conducted with the participants (average age 21) to assess the occurrence of traumatic experiences, suicide attempts and the development of PTSD.
Of the participants interviewed, 1,273 (81 percent) had been exposed to a traumatic event and 100 (6 percent, or 8 percent of those exposed to trauma) developed PTSD. Suicide had been attempted by 10 percent of those with PTSD, compared with 2 percent of those who were exposed to trauma but did not develop PTSD and 5 percent of those who had never been exposed to traumatic events.
"The mechanisms involved in the association between PTSD and suicide attempts are not known," the authors write. "There could be a common pre-existing predisposition to PTSD and suicide attempts that was present before the trauma occurred. Studies of early trauma and suicidal behaviors have implicated depression and impulsivity as possible mediators or possible pre-existing susceptibility traits."
Previous research has found that up to 20 percent of suicide attempts in young people are attributable to sexual abuse during childhood, the authors note. "Although we did not focus explicitly on child sexual abuse, our results point to the need to base risk estimates of attempted suicide on data that take into account the psychiatric response to the trauma. By distinguishing between trauma-exposed persons without and with PTSD, we found that it is PTSD that is associated with an increased risk of a suicide attempt. Whether or not this finding applies to sexual abuse in childhood or adulthood should be investigated in future studies."
This study was supported by grants from the National Institute of Mental Health and the National Institute on Drug Abuse.
- Wilcox et al. Posttraumatic Stress Disorder and Suicide Attempts in a Community Sample of Urban American Young Adults. Archives of General Psychiatry, 2009; 66 (3): 305 DOI: 10.1001/archgenpsychiatry.2008.557
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