Post-Traumatic Stress Disorder

Can You Get PTSD from Attempted Suicide?

Groundbreaking research defines and explores suicide attempt-related PTSD.

Posted Oct 10, 2019

"Suicide is a permanent solution to a temporary problem." —Phil Donahue

Suicide is a complex, distressing experience for all involved, affecting friends, family and co-workers deeply, at great psychological and material cost to individuals, families, community and society. More and more, we become aware that we face a suicide crisis.

Suicide accounts for upwards of 47,000 deaths per year as of 2019. Over 50 percent of people whose lives end in suicide did not have known mental health issues, suggesting a hidden epidemic. While many of the risk and protective factors are known, and prevention strategies are available, we aren't there yet.

Recent and ongoing celebrity suicides make us aware we are all vulnerable, while the deeply troubling escalating rates of suicide and revealed trauma among our nation’s military has ignited long-overdue motivation to make more headway against the scourge we face. Suicide is a problem across high-stress professions, including medicine, law enforcement, and others.  

The paradox of suicide is that while public awareness increases, private individuals continue to keep suicidal intentions private, a veil of lethal secrecy.

Suicide Prevention

Progress is being made. There is a consensus for a three-digit number designated exclusively for suicide emergencies. Current emergency resources, aside from 911, include hotlines such as the National Suicide Prevention Hotline, 1-800-273-TALK (8255).

Even experts in suicide prevention and resilience themselves may die by suicide, as we saw recently with Gregory Eells. Dr. Eells had become the head of counseling and psychological services at the University of Pennsylvania, recruited for his expertise in wellness and resilience.

Such events are profoundly unnerving because if experts are not safe, who is? They remind us of how vulnerable we all can be. Our understanding of suicide is the focus of much research, but in spite of progress, predicting and preventing suicide remains a major challenge.

Can One Get PTSD from Trying to End One's Life?

Given the critical interactions between trauma, distress and suicide, research is of ever-increasing urgency. One factor that has not been studied well empirically is whether attempts to end one’s own life can cause post-traumatic stress disorder (PTSD) in suicide survivors—and if so, what the implications are for the risk of additional future suicide attempts (SA).

In order to understand these factors, researchers from Florida State University, with funding from the U.S. Department of Defense, conducted a study (Stanley et al., 2019) of 386 SA survivors.

All participants, by study design, had a history of at least one suicide attempt. On average, the most lethal attempt was about 11 years prior to the time of the study, with a smaller group (12.7 percent) reporting the most lethal attempt within one year.

On average, participants were moderately depressed at the time of the study and were at elevated overall risk for future suicide—as would be expected based on past history. In terms of general PTSD, nearly 77 percent reported a prior life event which would be considered “traumatic” by diagnostic standards, with 4.1 percent noting this was their own SA.

Nearly 57 percent of the sample had high enough scores on a PTSD checklist, the PCL-5, to suggest a then-current PTSD diagnosis. Most (90.4 percent) reported a personal trauma, 21.5 percent reported witnessing trauma, 9.6 percent reported trauma happening to a close friend or relative, and 1.8 percent repeatedly heard about trauma professionally. Nearly 46 percent reported sexual violence and the majority (71.7 percent) reported multiple traumatic experiences.

How many participants met criteria for SA-specific PTSD? They looked at both cisgender and transgender participants. For cisgender participants, 27.2 percent of women and 21.4 percent of men scored high enough on a checklist developed for this study, the PCL-5-SA, to indicate PTSD specifically from attempted suicide. For transgender participants, over 52 percent were likely to have PTSD from their SAs.

Predictors of PTSD from SA included being younger, having a SA in the preceding year, having used multiple methods in the previous SA, and having an unrelated diagnosis of PTSD. Those with general PTSD already had almost 9-fold greater risk of SA-related PTSD compared to those who did not. Prior PTSD seems to amplify the risk of PTSD from suicide, while also contributing to the risk of suicide in the first place—part of a vicious cycle of unprocessed trauma.

The study also looked at who had the highest future suicide risk, via correlations with suicide intent. Suicide risk factors included 1) SA-related PTSD and 2) the presence of significant depression. When they looked at the depression-related risk for suicide intent, they found that risk was higher for people with less severe depression. 

This is consistent with recommendations for extra vigilance when patients are less depressed and still suicidal, or recovering from more severe depression and starting to feel better, because they may be more likely to act on suicide plans as energy and motivation return—and before symptoms like hopelessness, isolation, and emotional pain abate.

Silence Equals Death

This research makes a key contribution to our understanding of suicide by defining SA-related PTSD and identifying its potential value for predicting and preventing future suicidal behavior. Clinicians and people seeking help can evaluate for PTSD from SAs, and if it is present, provide robust therapeutic intervention and preventive measures. They can be aware of, ask about, and openly discuss how the presence of SA-related PTSD and its lingering, often unrecognized impact may feed future intent.

Treating depression fully, and exercising caution during recovery—including educating and engaging patients and loved ones—is key in preventing tragedy.

Secrecy can be lethal, and so powerful is the neurobiology and psychology of depression that people often feel no one cares or it doesn’t matter. But we do, and it does.

In a personal communication, John Draper, Ph.D., Vibrant Emotional Health’s Executive Director of the National Suicide Prevention Lifeline, had this to say about the research:

     "[T]hese findings are consistent with what we know about suicide re-attempts and suicides: they are most likely to occur within the first 2 years of the index attempt. Aside from the very excellent recommendation of SOSA support groups, the need for close follow-up care for the 1-2 year period after the attempt is vital [to reduce SA and suicides].

     "Also, the PTSD relationship to SA is best addressed in treatments focused on the suicidal thoughts, what is driving them, and what alleviates them (alongside strengthening reasons for living). The treatments that have been shown to most effectively reduce suicide are suicide-focused interventions, as opposed to primarily treating 'the underlying depression, anxiety, etc.'"

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