Does PTSD Mean You’re Suicidal?
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What an odd fucking question…

Of all the strange questions I’ve been asked by people (Vets, civilians, active duty, ect) I have to admit, this is the strangest one. “I have PTSD, does that mean I am going to kill myself?” My first question is always “Well, do you wanna?” Seriously… do ya? Look, growing up I always heard you should never come out and ask someone if they want to kill themselves, because that puts the idea in their head. FALSE! If they are to their breaking point, ending or continuing their life has already been considered; you asking is not putting the idea in their head. Plus, why beat around the bush? You should take immediate action if you really believe that someone is considering taking their life, no matter the consequences. Scroll to the bottom of this post for links and numbers if you don’t already have them. Don’t wait until it’s too late, don’t just do nothing because they might get angry with you, don’t hesitate to do the right thing. Act when it’s necessary. I’d rather lose a friend because I did something to save their life than to lose them because they took their life.
So, back to the question at hand… Are you suicidal because you have PTSD? The simplest answer to this question is no. There have been studies done that show a correlation between deployed service members and suicide… but there’s nothing that speaks in true certainty. One study says yes, another says no and yet another says who the fuck knows. The only way having PTSD means you’ll be suicidal is if you feel suicidal. Are you having thoughts of harming yourself? Do you think the world is better off without if you were dead? Do you want to die? If you aren’t sure or can’t say no to questions like this, call someone! The National Suicide Prevention Lifeline [1-800-273-TALK (1-800-273-8255) when prompted dial 1 if you are a vet] has people that are specifically trained to help you out. It’s a call that is easier to talk about than to make, but do what you have to do to find help.

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Why Does Everyone Say Vets are More Likely to Commit Suicide?

Ughhhhh, because they are. Veterans are more likely to commit suicide than the general civilian population. Looking at the VA’s report from last year vets are 22% (overall) more likely to kill themselves. Even the reported attempts were higher among vets than that of the general population. And before you start over thinking it… it’s not the entire population versus the small amount of veterans; it’s per 100,000 – so the correlation is valid. Scary and upsetting, but valid. Just to give you an idea of the numbers: From 1999-2010, the suicide rate in the US population among males was 19.4 per 100,000, compared to 4.9 per 100,000 in females. Based on the most recent data available, in fiscal year 2009, the suicide rate among male Veteran VA users was 38.3 per 100,000, compared to 12.8 per 100,000 in females. Now there are things to take into consideration with this like assisted suicide or terminally ill patients taking their lives instead of living out a disease, ect. But when you take it down to the basics, vets are more likely to commit suicide than civilians. This shouldn’t come as a surprise, but if it does there’s plenty of research you can do and a lot of opinions out there as to why this happens.

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How Common is Suicide?

It is challenging to determine an exact number of suicides. Many times, suicides are not reported and it can be very difficult to determine whether or not a particular individual’s death was intentional. For a suicide to be recognized, examiners must be able to say that the deceased meant to die. Other factors that contribute to the difficulty are differences among states as to who is mandated to report a death, as well as changes over time in the coding of mortality data. Data from the National Vital Statistics System, a collaboration between the National Center for Health Statistics of the U.S. Department of Health and Human Services and each US state, provides the best estimate of suicides. Overall, men have significantly higher rates of suicide than women. This is true for civilians and veterans. Suicide is becoming more and more of a headline in recent years as the number of young people (18 or younger) have begun taking their lives at an alarming rate. That doesn’t mean the number of suicides have gone up, or down… just like gun control, it just in the news more. A body of research indicates that there is a correlation between many types of trauma and suicidal behaviors. For example, there is evidence that traumatic events such as childhood abuse may increase a person’s suicide risk. A history of military sexual trauma also increases the risk for suicide and intentional self-harm, suggesting a need to screen for suicide risk in this population. Though considerable research has examined the relation between combat or war trauma and suicide, the relationship is not entirely clear – and may never be. Some studies have shown a relationship while others have not. There is strong evidence, though, that among Veterans who experienced combat trauma, the highest relative suicide risk is observed in those who were wounded multiple times and/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. This study assessed only combat trauma, not a diagnosis of PTSD, as a factor in the suicidal behavior. Basically, the more studies done, the less they can really say about the risk of suicide in correlation to veterans, combat veterans, or service connected veterans. So – PTSD doesn’t mean you’ll be suicidal and that fact alone should put some worries to bed.

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Suicide and PTSD: Does Treatment Help

Considerable debate exists about the reason for the heightened risk of suicide in trauma survivors. Whereas some studies suggest that suicide risk is higher among those who experienced trauma due to the symptoms of PTSD, others claim that suicide risk is higher in these individuals because of related psychiatric conditions. However, a study analyzing data from the National Comorbidity Survey, a nationally representative sample, showed that PTSD alone out of six anxiety diagnoses was significantly associated with suicidal ideation or attempts. While the study also found an association between suicidal behaviors and both mood disorders and antisocial personality disorder, the findings pointed to a robust relationship between PTSD and suicide after controlling for comorbid disorders. A later study using the Canadian Community Health Survey data also found that respondents with PTSD were at higher risk for suicide attempts after controlling for physical illness and other mental disorders. Some studies that point to PTSD as a precipitating factor of suicide suggest that high levels of intrusive memories can predict the relative risk of suicide. Anger and impulsivity have also been shown to predict suicide risk in those with PTSD. Further, some cognitive styles of coping such as using suppression to deal with stress may be additionally predictive of suicide risk in individuals with PTSD. Other research looking specifically at combat-related PTSD in Vietnam era Veterans 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. With respect to OIF/OEF Veterans, PTSD has been found to be a risk factor for suicidal ideation. Subthreshold PTSD also carries risk. A recent study found that among OIF/OEF Veterans, those with subthreshold PTSD were 3 times more likely to report hopelessness or suicidal ideation than those without PTSD.
Current practice guidelines for treatment of PTSD indicate that trauma-focused therapies are not recommended for individuals with “significant suicidality”. Because “suicidality” is a vague term and there is no guidance for what significant suicidality means, they interpret this recommendation to pertain to actively suicidal patients, or those in an acute clinical emergency for whom suicidality should be addressed without delay. Providers must therefore use clinical judgment prior to initiating and throughout trauma-focused therapy. Individuals with PTSD who present with intermittent but manageable suicidal thoughts may benefit from trauma-focused therapy. Two effective treatments for PTSD, Cognitive Processing Therapy (CPT) and prolonged exposure have been shown to reduce suicidal ideation. A recent study that randomized women who experienced rape into CPT or PE treatment found that reductions in PTSD symptoms were associated with decreases in suicidal ideation throughout treatment. The reductions were maintained over a 5-10 year follow-up period. The effect of PTSD treatment on suicidal ideation was greater for women who completed CPT. Further research is needed to provide additional evidence in other populations.

What Can You Take Away From This?

PTSD doesn’t mean you are going to kill yourself. Nor does any other mental health issue. It does, however, put you at a greater risk. If you are considering suicide, feeling hopeless, feeling “un-safe”, or if you know someone who is – don’t hesitate to save a life. Call the suicide hotline, call your doctor’s office, contact me through the blog, call your local VA mental health clinic, go to the emergency room. I lost four friends, people that I loved and held a lot of respect for, to suicide. The pain and guilt that I feel to this day is indescribably difficult to handle. Not a day goes by that I don’t think about them, miss them, love them, and would give anything for one more chance to see them. Don’t leave like that, don’t do that to the people that love you – even if it seems like they are better off without you. If you can’t help yourself for you, do it for everyone that will be left in this world with a hole in their hearts that will never be filled again. 

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Links and Shit

National Suicide Prevention Lifeline: 1-800-273-TALK (1-800-273-8255). To be routed to the Veterans Crisis Line, dial 1 after being connected.
NSP Chat Line
Mental Health VA
Yellow Ribbon
Real Warriors

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