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Suicide risk in people with post-traumatic stress disorder: a cohort study of 3.1 million people in Sweden

Fox, V; Dalman, C; Dal, H; Hollander, A-C; Kirkbride, JB; Pitman, A; (2021) Suicide risk in people with post-traumatic stress disorder: a cohort study of 3.1 million people in Sweden. Journal of Affective Disorders , 279 pp. 609-616. 10.1016/j.jad.2020.10.009. Green open access

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Abstract

BACKGROUND: It is unclear whether post-traumatic stress disorder [PTSD] is associated with suicide risk in the general population, whether this differs by sex, or what the population impact of PTSD is for suicide. METHODS: We constructed a nationwide cohort of all people living in Sweden, born 1973-1997, followed from their 14th birthday (or immigration, if later) until suicide, other death, emigration or 31 December 2016. We used Cox proportional hazards regression to estimate hazard ratios [HR], and calculated the population impact of PTSD on suicide. We included sensitivity analyses to explore effects of outcome and exposure definitions, and to account for potential competing risks. RESULTS: Of 3,177,706 participants, 22,361 (0•7%) were diagnosed with PTSD, and 6,319 (0•2%) died by suicide over 49•2 million person-years. Compared with women and men without PTSD, suicide rates were 6•74 (95%CI: 5•61-8•09) and 3•96 (95%CI: 3•12-5•03) times higher in those with PTSD, respectively, after sociodemographic adjustment. Suicide rates remained elevated in women (HR: 2•61; 95%CI: 2•16-3•14) and men (HR: 1•67; 95%CI: 1•31-2•12) after adjustment for previous psychiatric conditions; attenuation was driven by previous non-fatal suicide attempts. Findings were insensitive to definitions or competing risks. If causal, 1•6% (95%CI: 1•2-2•1) of general population suicides could be attributed to PTSD, and up to 53.7% (95%CI: 46.1-60.2) in people with PTSD. LIMITATIONS: Residual confounding remains possible due to depressive and anxiety disorders diagnosed in primary care but unrecorded in these registers. CONCLUSIONS: Clinical guidelines for the management of people with PTSD should recognise increased suicide risk.

Type: Article
Title: Suicide risk in people with post-traumatic stress disorder: a cohort study of 3.1 million people in Sweden
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jad.2020.10.009
Publisher version: https://doi.org/10.1016/j.jad.2020.10.009
Language: English
Additional information: © 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Keywords: suicide, post-traumatic stress disorder, PTSD, epidemiology, cohort study
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/10112465
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