UCL Division of Psychiatry, University College London, UK.
Whittington Health, London, UK.
Int J Psychiatry Clin Pract. 2023 Jun;27(2):151-160. doi: 10.1080/13651501.2022.2140679. Epub 2022 Nov 11.
Post-traumatic stress disorder (PTSD) is a risk factor for suicidality (suicidal ideation, and suicide attempt). This study described the prevalence of suicidality amongst a representative sample of individuals with PTSD and the association between suicidality and receipt of five PTSD treatments.
We analysed deidentified data for patients being treated for PTSD at Camden and Islington NHS Foundation Trust between 2009 and 2017 obtained via the Clinical Record Interactive Search tool. We described the sample's sociodemographic and clinical characteristics and used stepwise logistic regression to investigate the association between suicidality and receipt of four, specific PTSD treatments: psychotherapy, antidepressant/antianxiety medication, antipsychotics, benzodiazepines. We used Cox proportional hazards regression to investigate the association between suicidality and hospital/crisis team admission.
Of 745 patients diagnosed with PTSD, 60% received psychotherapy and 66% received psychotropic medication. Those who reported suicidality (6%) were no more likely than those who did not to be prescribed antidepressant/antianxiety medication, but were more likely to receive antipsychotics (AOR = 2.27, 95% CI 1.15 - 4.47), benzodiazepines (AOR 2.28, 95% CI 1.17 - 4.44), psychotherapy (AOR 2.60, 95% CI 1.18 - 5.73) and to be admitted to hospital/crisis team (AOR 2.84, 95% 1.82 - 4.45).
In this sample, patients with PTSD and suicidality were more likely to receive psychiatric medication, psychotherapy and psychiatric admission than those who were not suicidal. Overall patients were more likely to receive psychotropic medication than psychotherapy. Adherence to clinical guidelines is important in this population to improve treatment outcomes and reduce the risk of suicide.KEY POINTSNICE guidelines recommend psychological therapy be first line treatment for PTSD, yet we identified that fewer people diagnosed with PTSD received therapy compared to psychotropic medication.Patients with suicidality were more likely to receive antipsychotics and benzodiazepines, yet not antidepressant/antianxiety medication although given that suicidality is characteristic of severe depression, it might be assumed from stepped care models that antidepressant/antianxiety medication be prescribed before antipsychotics.The high proportion of patients prescribed antipsychotics suggests a need for better understanding of psychosis symptoms among trauma-exposed populations.Identifying which combinations of symptoms are associated with suicidal thoughts could help tailor trauma-informed approaches to discussing therapy and medication.
创伤后应激障碍（PTSD）是自杀倾向（自杀意念和自杀企图）的一个风险因素。本研究描述了 PTSD 患者代表性样本中自杀倾向的流行情况，以及自杀倾向与接受五种 PTSD 治疗之间的关联。
我们通过临床记录互动搜索工具分析了 2009 年至 2017 年期间在卡姆登和伊斯灵顿国民保健服务基金会信托接受 PTSD 治疗的患者的匿名数据。我们描述了样本的社会人口统计学和临床特征，并使用逐步逻辑回归来调查自杀倾向与接受四种特定 PTSD 治疗之间的关联：心理治疗、抗抑郁药/抗焦虑药、抗精神病药、苯二氮䓬类药物。我们使用 Cox 比例风险回归来调查自杀倾向与住院/危机小组入院之间的关联。
在 745 名被诊断患有 PTSD 的患者中，60%接受了心理治疗，66%接受了精神药物治疗。报告有自杀倾向（6%）的患者与没有自杀倾向的患者相比，更不可能开抗抑郁药/抗焦虑药，但更有可能开抗精神病药（OR = 2.27，95%CI 1.15-4.47）、苯二氮䓬类药物（OR 2.28，95%CI 1.17-4.44）、心理治疗（OR 2.60，95%CI 1.18-5.73）和住院/危机小组入院（OR 2.84，95%CI 1.82-4.45）。
在本样本中，有自杀倾向的 PTSD 患者比没有自杀倾向的患者更有可能接受精神药物治疗、心理治疗和住院/危机小组入院。总体而言，患者更有可能接受精神药物治疗而非心理治疗。在这一人群中，遵循临床指南对于改善治疗结果和降低自杀风险非常重要。
NICE 指南建议心理治疗作为 PTSD 的一线治疗，但我们发现与接受抗抑郁药/抗焦虑药治疗相比，接受 PTSD 治疗的患者较少。有自杀倾向的患者更有可能接受抗精神病药和苯二氮䓬类药物治疗，但没有接受抗抑郁药/抗焦虑药治疗，尽管考虑到自杀倾向是严重抑郁症的特征，从阶梯式护理模式来看，可能会开抗抑郁药/抗焦虑药治疗。
抗精神病药物处方的高比例表明需要更好地了解创伤后人群中的精神病症状。确定哪些症状组合与自杀意念相关可能有助于针对治疗和药物治疗制定创伤知情方法。
