Akbar Rahat, Arya Vikas, Conroy Elizabeth, Wilcox Holly C, Page Andrew
Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia.
Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
Suicide Life Threat Behav. 2023 Feb;53(1):163-184. doi: 10.1111/sltb.12931. Epub 2022 Nov 16.
This study conducted a systematic review and meta-analysis of the association between posttraumatic stress disorder (PTSD) and (i) death by suicide, (ii) attempted suicide (AS), and (iii) suicidal ideation (SI).
The systematic review identified seven studies on PTSD and suicide, 33 studies for AS, and 20 studies for SI. A series of stratified meta-analyses were conducted to estimate pooled effects, in addition to meta-regression to investigate sources of heterogeneity.
A higher relative risk of suicide was evident among those diagnosed with PTSD (RR = 2.09 [95% confidence interval (CI): 1.11-3.94]), with strongest associations among combat veterans (RR = 3.97, 95% CI 2.22-7.10). A lower relative risk of suicide among those with PTSD and co-morbid psychiatric conditions was evident (RR = 0.74, 95% CI 0.63-0.86). A strong association between PTSD and attempted suicide (RR = 4.05, 95% CI 3.14-5.23) and suicidal ideation (RR = 2.91, 95% CI 2.22-3.82) was also found, with a consistently strong association among those with co-morbid psychiatric conditions and non-clinical cohorts.
This review found a strong association between PTSD and death by suicide, attempted suicide, and suicidal ideation, and also suicide among veteran populations. Early identification and treatment of PTSD across both clinical and non-clinical cohorts should be a priority for suicide prevention.
本研究对创伤后应激障碍（PTSD）与（i）自杀死亡、（ii）自杀未遂（AS）和（iii）自杀意念（SI）之间的关联进行了系统评价和荟萃分析。
该系统评价纳入了7项关于PTSD与自杀的研究、33项关于自杀未遂的研究以及20项关于自杀意念的研究。除了进行荟萃回归以调查异质性来源外，还进行了一系列分层荟萃分析以估计合并效应。
诊断为PTSD的人群自杀相对风险更高（RR = 2.09 [95%置信区间（CI）：1.11 - 3.94]），在退伍军人中关联最强（RR = 3.97，95% CI 2.22 - 7.10）。PTSD合并精神疾病的人群自杀相对风险较低（RR = 0.74，95% CI 0.63 - 0.86）。还发现PTSD与自杀未遂（RR = 4.05，95% CI 3.14 - 5.23）和自杀意念（RR = 2.91，95% CI 2.22 - 3.82）之间存在强关联，在合并精神疾病的人群和非临床队列中关联持续较强。
本综述发现PTSD与自杀死亡、自杀未遂和自杀意念之间存在强关联，在退伍军人人群中与自杀也存在强关联。在临床和非临床队列中对PTSD进行早期识别和治疗应作为自杀预防的优先事项。
