Forehand Jenna A, Dufort Vincent, Gradus Jaimie L, Maguen Shira, Watts Bradley V, Jiang Tammy, Holder Nicholas, Shiner Brian
Veterans Affairs Medical Center, White River Junction, Vermont, USA.
Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA; and Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.
Br J Psychiatry. 2022 Aug 23:1-7. doi: 10.1192/bjp.2022.110.
There is mixed evidence regarding the direction of a potential association between post-traumatic stress disorder (PTSD) and suicide mortality.
This is the first population-based study to account for both PTSD diagnosis and PTSD symptom severity simultaneously in the examination of suicide mortality.
Retrospective study that included all US Department of Veterans Affairs (VA) patients with a PTSD diagnosis and at least one symptom severity assessment using the PTSD Checklist (PCL) between 1 October 1999 and 31 December 2018 ( = 754 197). We performed multivariable proportional hazards regression models using exposure groups defined by level of PTSD symptom severity to estimate suicide mortality rates. For patients with multiple PCL scores, we performed additional models using exposure groups defined by level of change in PTSD symptom severity. We assessed suicide mortality using the VA/Department of Defense Mortality Data Repository.
Any level of PTSD symptoms above the minimum threshold for symptomatic remission (i.e. PCL score >18) was associated with double the suicide mortality rate at 1 month after assessment. This relationship decreased over time but patients with moderate to high symptoms continued to have elevated suicide rates. Worsening PTSD symptoms were associated with a 25% higher long-term suicide mortality rate. Among patients with improved PTSD symptoms, those with symptomatic remission had a substantial and sustained reduction in the suicide rate compared with those without symptomatic remission (HR = 0.56; 95% CI 0.37-0.88).
Ameliorating PTSD can reduce risk of suicide mortality, but patients must achieve symptomatic remission to attain this benefit.
关于创伤后应激障碍（PTSD）与自杀死亡率之间潜在关联的方向，证据不一。
这是第一项在研究自杀死亡率时同时考虑PTSD诊断和PTSD症状严重程度的基于人群的研究。
回顾性研究，纳入了1999年10月1日至2018年12月31日期间所有被诊断为PTSD且至少使用PTSD检查表（PCL）进行过一次症状严重程度评估的美国退伍军人事务部（VA）患者（n = 754197）。我们使用由PTSD症状严重程度水平定义的暴露组进行多变量比例风险回归模型，以估计自杀死亡率。对于有多个PCL评分的患者，我们使用由PTSD症状严重程度变化水平定义的暴露组进行了额外的模型分析。我们使用VA/国防部死亡率数据存储库评估自杀死亡率。
任何高于症状缓解最低阈值的PTSD症状水平（即PCL评分>18）与评估后1个月的自杀死亡率翻倍相关。这种关系随时间减弱，但中度至高度症状的患者自杀率仍持续升高。PTSD症状恶化与长期自杀死亡率高25%相关。在PTSD症状改善的患者中，与未实现症状缓解的患者相比，实现症状缓解的患者自杀率有大幅且持续的降低（HR = 0.56；95%CI 0.37 - 0.88）。
改善PTSD可降低自杀死亡风险，但患者必须实现症状缓解才能获得此益处。
