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.
Preview |
Text
Pitman_Suicide risk in people with post-traumatic stress disorder- a cohort study of 3.1 million people in Sweden_AAM.pdf - Accepted Version Download (327kB) | Preview |
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 |
Archive Staff Only
 |
View Item |
