This fact sheet explores the relationship between PTSD and
suicide. It also addresses important questions about
understanding and coping with suicide. This fact sheet is not
intended to replace mental health assistance obtained from a
professional.
Does PTSD increase an individuals suicide risk?
A large body of research indicates that there is a correlation
between PTSD and suicide. There is evidence that traumatic events
such as sexual abuse, combat trauma, rape, and domestic violence
generally increase a persons suicide risk. Considerable
debate exists, however, about the reason for this increase.
Whereas some studies suggest that suicide risk is higher due to
the symptoms of PTSD, others claim that suicide risk is higher in
these individuals because of related psychiatric conditions. Some studies that
point to PTSD as the cause of suicide suggest that high levels of
intrusive memories can predict the relative risk of suicide. High levels of arousal symptoms and low levels of
avoidance have also been shown to predict suicide risk. In contrast, other researchers have found that
conditions that co-occur with PTSD, such as depression, may be
more predictive of suicide.
Furthermore, some cognitive styles of coping, such as using
suppression to deal with stress, may be additionally predictive
of suicide risk in individuals with PTSD.
Given the high rate of PTSD in veterans, considerable research
has examined the relation between PTSD and suicide in this
population. Multiple factors contribute to suicide risk in
veterans. Some of the most common factors are listed below:
male gender
alcohol abuse
family history of suicide
older age
poor social-environmental support (exemplified by
homelessness and unmarried status)
possession of firearms
the presence of medical and psychiatric conditions
(including combat-related PTSD) associated with suicide
Currently there is debate about the exact influence of
combat-related trauma on suicide risk. For those veterans who
have PTSD as a result of combat trauma, however, it appears that
the highest relative suicide risk is in veterans who were wounded
multiple times or hospitalized for a wound. This suggests that the intensity of the combat trauma, and
the number of times it occurred, may influence suicide risk in
veterans with PTSD. Other research on veterans with
combat-related PTSD suggests that the most significant predictor
of both suicide attempts and preoccupation with suicide is
combat-related guilt. Many veterans
experience highly intrusive thoughts and extreme guilt about acts
committed during times of war. These thoughts can often overpower
the emotional coping capacities of veterans.
Reasons for suicide
Individuals who have lost someone to suicide often question
why that person chose to end his or her life. Unfortunately,
there is no easy answer to this question. Suicide often appears
to be related to environmental stresses or traumatic events, but
it is also the case that some individuals commit suicide without
any identifiable reason. Although survivors will always feel
devastation and confusion when a loved one commits suicide,
available research may help survivors better understand some
common reasons for suicide.
Specific reasons for suicide are as diverse as the individuals
who commit it. Nevertheless, there are some common causal factors
that appear to be related to suicide. For example, more than 90%
of suicide victims have a significant psychiatric illness at the
time of their death. These
illnesses are often both undiagnosed and untreated. The two most
common psychiatric conditions associated with suicide are mood
disorders and substance abuse. When an individual has both a mood disorder and a
substance abuse issue, the risk of suicide is much higher. This
is especially the case for adolescents and young adults. This research suggests that
the presence of mental illness is a primary contributor to the
cause of suicide. For individuals who suffer from clinical
depression specifically, of utmost concern are those who exhibit
open aggression, anxiety, or agitation, as these factors
significantly increase the risk of suicide.
Some researchers suggest that suicide can be understood as a
type of coping mechanism for individuals who feel overwhelmed and
trapped by their situations. For these people, suicide is seen as
a way of dealing with extremely strong negative emotions through
escape. This conceptualization of suicide is exemplified by the
relation between suicide rates and media coverage, particularly
in the young. Research reveals that the
magnitude of increase in suicides following a suicide story is
proportional to the amount, duration, and prominence of media
coverage. These data suggest that suicide is more
likely to occur when it is no longer perceived as
taboo and instead is seen as a viable coping method
for stress. This hypothesis of suicide as a coping device is
further supported by evidence that a family history of suicide
greatly increases an individuals suicide risk, regardless
of the presence of mental illness.
When trying to understand suicide, some helpful questions to
consider are:
Did the individual ever receive treatment for depression or
another mental disorder?
Did the individual have a problem with substance
abuse?
Did the individual have a history of suicide attempts?
Did the individual have a family history of suicide
attempts?
Suicide as a traumatic event
A considerable amount of research examines exposure to suicide
as a traumatic event. Studies show that trauma from exposure to
suicide can contribute to PTSD. In particular, adults and
adolescents are more likely to develop PTSD as a result of
exposure to suicide if one or more of the following conditions
are true: if they witness the suicide, if they are very connected
with the person who dies, or if they have a history of
psychiatric illness. However, relative to other traumatic
events, there appears to be nothing unique about developing PTSD
as a consequence of exposure to suicide. Studies do show, however, that
traumatic grief is more likely to arise after exposure to
traumatic death such as suicide. Traumatic
grief refers to a syndrome in which individuals experience
functional impairment, a decline in physical health, and suicidal
ideation. These symptoms occur independent of other conditions
such as depression and anxiety. For more
information about traumatic grief please refer to the Managing
Grief fact sheet.
What can I do?
I am suicidal
Everyone feels down occasionally. Feeling suicidal, however,
is not normal. If you have thoughts about hurting yourself, it is
important to seek professional help. Many people who experience
suicidal thoughts also struggle with a mood disorder or substance
abuse problem. If you think you may have one of these conditions,
there are many places to seek help. For conditions such as PTSD,
depression, or substance abuse, helpful treatments include
medication from a primary care physician or psychiatrist, and
therapy from a mental health provider such as a psychologist. To
locate a mental health provider near you, call your doctor's
office or ask a friend for a recommendation. The following link
may also be a helpful way to locate a mental health professional
http://www.mentalhealth.samhsa.gov/databases/.
If you work for a large company or organization, call the human
resources office to find out if they provide mental health
services or make referrals. If you are ever considering suicide
and feel unsafe, you may call the following hotline (available 24
hours a day) to speak with someone who can help: 1-800-273-TALK (1-800-273-8255) (en Español 1-888-628-9454).
If you do not struggle with a psychiatric illness, you may
need to learn additional coping strategies for high levels of
stress. There are many therapeutic treatments that could be
helpful in this situation. Consider using one of the methods
mentioned above to locate a mental health professional near
you.
Someone I know is suicidal
It is likely that sometime during your life you will be
exposed to a family member, peer, or coworker who is feeling
suicidal. When someone discloses information about feeling
suicidal, the information can be overwhelming, anxiety provoking,
and frightening. This is particularly true if the disclosure is
made in confidence and you feel pressure not to share the
information with others. If someone you know is thinking about
suicide, the issue should be taken very seriously. Individuals
who contemplate suicide may not necessarily take action, but
evaluating the risk can be complicated and should be done by a
qualified mental health professional.
Helping a suicidal individual can be a difficult process. The
persons age will influence your first course of action. If
your acquaintance is an adult, try to be supportive and listen to
his or her concerns. Next, encourage that person to seek
treatment immediately. Help the person with this process by
remaining calm and providing information about mental health
options in the area. Call 1-800-273-TALK (1-800-273-8255) or visit
http://www.mentalhealth.samhsa.gov/databases/
to obtain referral information.
Often the most difficult part of obtaining treatment is the
initial call to a mental health professional. It is usually
easier for a suicidal individual to accept professional help if
they have assistance with this part of the process. The decision
to seek treatment is typically voluntary for adults. Their
ability to maintain safety will determine the treatment options.
Options include outpatient therapy, medication management, and
inpatient treatment. Inpatient hospital visits are typically only
prescribed when an individual is no longer safe without
supervision. Sometimes involuntary hospital admission is
necessary. However, because of federal laws protecting adult
civil rights, this course of action in uncommon. Involuntary
admission only occurs when an individual demonstrates unsafe
behavior. If you feel that your acquaintance may hurt him- or
herself or others, contact your local police department for
assistance.
If the person with suicidal thoughts is a minor (under the age
of 18), it is important to contact the minors parent or
legal guardian. If the caregiver is unwilling or unable to take
action, contact a mental health professional or law enforcement
agent for assistance. United States federal law states that
individuals under the age of 18 are not able to make mental
health treatment decisions. Therefore, it is important that
responsible adults see that minors receive the appropriate
services. Treatment options for children and adolescents are
similar to those outlined for adults. Unlike adults, however,
minors may receive inpatient hospitalization without their
consent if it is deemed necessary by their parents or the legal
system.
While helping a suicidal person can be a difficult process,
remember that the assistance you provide could save
someones life.
Someone I know has committed suicide
It is always difficult to cope when an acquaintance commits
suicide. Overcoming the suicide will be particularly challenging
if you were emotionally close to the victim, if you witnessed the
event, or if you have a prior history of psychiatric illness.
Additional factors that complicate the grieving process include
low socioeconomic status and low social support. Grieving the loss of a loved one is a natural
process. It may take several months to feel normal
again after your acquaintance commits suicide. Due to the
traumatic nature of suicide, you may experience traumatic grief
as part of the healing process. If you experience pronounced
levels of grief several months after the suicide, contact a
mental health professional for assistance. Lastly, many people experience intense
guilt following the suicide of an acquaintance. This feeling is
often related to thoughts about being unable to prevent the
suicide. Suicide is never your fault. It is a complicated and
difficult phenomenon to understand, with many contributing
factors. To gain a better understanding of suicide or the
grieving process, consider finding a mental health provider at
http://www.mentalhealth.samhsa.gov/databases/.
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