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Which Posttraumatic Stress Disorder Symptoms, Trauma Types, and Substances Correlate With Suicide Attempts in Trauma Survivors?

Jeffrey Guina, MD; Ramzi W. Nahhas, PhD; Nicholas Mata, MD; and Seth Farnsworth, MD

Published: October 26, 2017

Article Abstract

Objective: To examine among trauma survivors several potential suicide risk factors, some of which have never been studied in this population (eg, DSM-5 posttraumatic stress disorder [PTSD] symptoms, benzodiazepines).

Methods: Using a cross-sectional self-report survey methodology in a consecutive sample of adult outpatients with trauma (N = 480), we examined relationships between suicide attempts and demographics, trauma types, PTSD symptoms, substance-related problems, and benzodiazepine prescriptions. The study was conducted from October 2014 to February 2015.

Results: PTSD diagnosis was significantly correlated with suicide attempt prevalence (adjusted odds ratio [AOR] = 2.6) and was the variable most strongly associated with the number of attempts among participants with at least 1 suicide attempt. PTSD symptom severities (total, cluster, and all but 3 individual symptoms) significantly correlated with attempted suicide; recklessness (AOR = 1.7), anhedonia (AOR = 1.7), and negative beliefs (AOR = 1.6) were most strongly correlated. Mood/cognitive alterations—a cluster new to the DSM-5—were particularly associated with suicide attempts (AOR = 3.2). Childhood maltreatment was strongly associated with attempted suicide; childhood physical abuse (AOR = 2.9) was the only trauma type significantly correlated with suicide attempts after adjustment for multiple testing. Attempted suicide was significantly correlated with substance-related problems in general (AOR = 2.6) and alcohol specifically (AOR = 2.9).

Conclusions: As predicted, suicide attempts correlated with PTSD symptom severity, childhood maltreatment, and substance-related problems. Our hypothesized correlation between suicide and benzodiazepine prescriptions was in part explained by PTSD symptom severity.

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