Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article
Short Report

Is Suicidal Behavior in Mood Disorders Altered by Comorbid PTSD?

Published Online:July 27, 2018https://doi.org/10.1027/0227-5910/a000532

Abstract

Abstract.Background: Suicide is a leading cause of death among US veterans. Associations between depression, posttraumatic stress disorder (PTSD), and suicidal behaviors have been found in this population, yet minimal research has explored how manifestations of self-injurious behavior (SIB) may vary among different diagnostic presentations. Aims: This study aimed to identify clinically useful differences in SIB among veterans who experience comorbid mood disorder and PTSD (CMP) compared with those who experience a mood disorder alone (MDA). Method: Participants were 57 US military veterans who reported an incident of intentional SIB. The semistructured Post Self-Injury/Attempted Self-Injury Debriefing Interview was used to examine characteristics of the SIB. Results: Veterans diagnosed with CMP were more likely than those with MDA to (a) report that the SIB was impulsive and (b) to be under the influence of substances at the time of self-injury. Limitations: Generalizability may be limited by small sample size and predominantly European American, male demographics. While highly relevant to routine clinical practice, caution is recommended, as study diagnoses were attained from medical records rather than structured interviews. Conclusion: Safety planning that emphasizes protection against impulsive suicide attempts (e.g., means restriction) may be especially important among veterans with comorbid mood disorder and PTSD.

References

  • Anestis, M. D., & Green, B. A. (2015). The impact of varying levels of confidentiality on disclosure of suicidal thoughts in a sample of United States National Guard personnel. Journal of Clinical Psychology, 71, 1023–1030. 10.1002/jclp.22198 First citation in articleCrossref Medline, Google Scholar

  • Britton, P. C., Bohnert, K. M., Ilgen, M. A., Kane, C., Stephens, B., & Pigeon, W. R. (2017). Suicide mortality among male veterans discharged from Veterans Health Administration acute psychiatric units from 2005 to 2010. Social Psychiatry and Psychiatric Epidemiology, 52, 1–7. First citation in articleCrossref Medline, Google Scholar

  • Bullman, T. A., & Kang, H. K. (1994). Posttraumatic stress disorder and the risk of traumatic deaths among Vietnam veterans. The Journal of Nervous and Mental Disease, 182, 604–610. First citation in articleCrossref Medline, Google Scholar

  • Busch, K., Fawcett, J., & Jacobs, D. (2003). Clinical correlates of inpatient suicide. Journal of Clinical Psychiatry, 64, 14–19. 10.4088/JCP.v64n0105 First citation in articleCrossref Medline, Google Scholar

  • Capron, D. W., Fitch, K., Medley, A., Blagg, C., Mallott, M., & Joiner, T. (2012). Role of anxiety sensitivity subfactors in suicidal ideation and suicide attempt history. Depression and Anxiety, 29, 195–201. 10.1002/da.20871 First citation in articleCrossref Medline, Google Scholar

  • Conner, K. R., Bohnert, A. S., McCarthy, J. F., Valenstein, M., Bossarte, R., Ignacio, R., … Ilgen, M. A. (2013). Mental disorder comorbidity and suicide among 2.96 million men receiving care in the Veterans Health Administration health system. Journal of Abnormal Psychology, 122, 256–263. First citation in articleCrossref Medline, Google Scholar

  • Conner, K. R., Bossarte, R. M., He, H., Arora, J., Lu, N., Tu, X. M., & Katz, I. R. (2014). Posttraumatic stress disorder and suicide in 5.9 million individuals receiving care in the Veterans Health Administration health system. Journal of Affective Disorders, 166, 1–5. 10.1016/j.jad.2014.04.067 First citation in articleCrossref Medline, Google Scholar

  • Fawcett, J., & Rosenblate, R. (2000). Suicide within 24 hours after assessment in the emergency department: Look for and manage anxiety. Psychiatric Annals, 30, 228–231. First citation in articleCrossref, Google Scholar

  • Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., … Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143, 187–232. 10.1037/bul0000084 First citation in articleCrossref Medline, Google Scholar

  • Freedenthal, S. (2008). Assessing the wish to die: A 30-year review of the suicide intent scale. Archives of Suicide Research, 12, 277–298. First citation in articleCrossref Medline, Google Scholar

  • Gradus, J. L. (2017). PTSD and death from suicide. PTSD Research Quarterly, 28, 1–8. First citation in articleGoogle Scholar

  • Kleespies, P. M., AhnAllen, C. G., Knight, J. A., Presskreischer, B., Barrs, K. L., Boyd, B. L., & Dennis, J. P. (2011). A study of self-injurious and suicidal behavior in a veteran population. Psychological Services, 8, 236–250. First citation in articleCrossref, Google Scholar

  • Klonsky, E. D., & May, A. M. (2014). Differentiating suicide attempters from suicide ideators: A critical frontier for suicidology research. Suicide and Life-Threatening Behavior, 44, 1–5. 10.1111/sltb.12068 First citation in articleCrossref Medline, Google Scholar

  • Nock, M., & Favazza, A. (2009). Nonsuicidal self-injury: Definition and classification. In M. NockEd., Understanding nonsuicidal self-injury: Origins, assessment, and treatment. Washington, DC: APA Books. First citation in articleGoogle Scholar

  • Nock, M. K., Hwang, I., Sampson, N. A., & Kessler, R. C. (2010). Mental disorders, comorbidity and suicidal behavior: Results from the National Comorbidity Survey Replication. Molecular Psychiatry, 15, 868–876. 10.1038/mp.2009.29 First citation in articleCrossref Medline, Google Scholar

  • Oquendo, M., Brent, D. A., Birmaher, B., Greenhill, L., Kolko, D., Stanley, B., … Mann, J. J. (2005). Posttraumatic stress disorder comorbid with major depression: Factors mediating the association with suicidal behavior. American Journal of Psychiatry, 162, 560–566. 10.1176/appi.ajp.162.3.560 First citation in articleCrossref Medline, Google Scholar

  • Pfeiffer, P. N., Brandfon, S., Garcia, E., Duffy, S., Ganoczy, D., Kim, H. M., & Valenstein, M. (2014). Predictors of suicidal ideation among depressed veterans and the interpersonal theory of suicide. Journal of Affective Disorders, 152, 277–281. 10.1016/j.jad.2013.09.025 First citation in articleCrossref Medline, Google Scholar

  • Serafini, G., Pompili, M., Innamorati, M., Rihmer, Z., Sher, L., & Girardi, P. (2012). Can cannabis increase the suicide risk in psychosis? A critical review. Current Pharmaceutical Design, 18, 5165–5187. First citation in articleCrossref Medline, Google Scholar

  • Shen, Y. C., Cunha, J. M., & Williams, T. V. (2016). Time-varying associations of suicide with deployments, mental health conditions, and stressful life events among current and former US military personnel: A retrospective multivariate analysis. The Lancet Psychiatry, 3, 1039–1048. 10.1016/S2215-0366(16)30304-2 First citation in articleCrossref Medline, Google Scholar

  • Shneidman, E. S. (1987). A psychological approach to suicide. In G. R. Van den BosB. K. BryantEds., Master lectures series. Cataclysms, crises, and catastrophes: Psychology in action (pp. 147–183). Washington, DC: American Psychological Association. First citation in articleGoogle Scholar

  • Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256–264. First citation in articleCrossref, Google Scholar

  • U.S. Department of Veterans Affairs. (2016, July 7). VA conducts nation's largest analysis of veteran suicide [Press release]. Retrieved from http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2801 First citation in articleGoogle Scholar

  • Wisco, B. E., Marx, B. P., Wolf, E. J., Miller, M. W., Southwick, S. M., & Pietrzak, R. H. (2014). Posttraumatic stress disorder in the US veteran population: Results from the National Health and Resilience in Veterans Study. The Journal of Clinical Psychiatry, 75, 1338–1346. 10.4088/JCP.14m09328 First citation in articleCrossref Medline, Google Scholar

  • Zivin, K., Kim, H. M., McCarthy, J. F., Austin, K. L., Hoggatt, K. J., Walters, H., & Valenstein, M. (2007). Suicide mortality among individuals receiving treatment for depression in the Veterans Affairs health system: Associations with patient and treatment setting characteristics. American Journal of Public Health, 97, 2193–2198. 10.2105/AJPH.2007.115477 First citation in articleCrossref Medline, Google Scholar