A Comparison of Dimensional and Categorical Approaches to Characterizing the Association Between Posttraumatic Stress Disorder and Future Suicide Attempts

The associations between repetitive negative thinking, insomnia symptoms, and sleep quality in adults with a history of trauma

BACKGROUND

Posttraumatic stress disorder (PTSD) and sleep disturbance are highly comorbid and repetitive negative thinking (RNT) is associated with both sleep disturbance and PTSD. However, few studies have examined the association between RNT and sleep disturbance in individuals exposed to trauma, with and without PTSD.

METHOD

Associations between trait-level and trauma-related RNT, insomnia, and sleep quality were investigated in a trauma-exposed MTurk (N = 342) sample. Additionally, PTSD symptom severity was tested as a moderator of the associations between RNT and insomnia and sleep quality.

RESULTS

Trait-level RNT predicted poorer sleep quality and greater insomnia, regardless of PTSD severity. Trauma-related RNT was also associated with greater insomnia, though the effect was moderated by PTSD severity such that it was significant for participants with low and moderate, but not severe, PTSD. Both trait- and trauma-related RNT were associated with several specific aspects of sleep quality, including: sleep disturbances, daytime dysfunction, use of sleep medications, sleep onset latency, and subjective sleep quality.

CONCLUSIONS

This study demonstrates significant associations linking RNT with insomnia and sleep disturbance in trauma-exposed individuals. Clinically, results suggest that it may be helpful to target both general and trauma-related RNT in sleep interventions for trauma-exposed individuals with insomnia.

Association between post-traumatic stress disorder severity and death by suicide in US military veterans: retrospective cohort study

BACKGROUND

There is mixed evidence regarding the direction of a potential association between post-traumatic stress disorder (PTSD) and suicide mortality.

AIMS

This is the first population-based study to account for both PTSD diagnosis and PTSD symptom severity simultaneously in the examination of suicide mortality.

METHOD

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 (n = 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.

RESULTS

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).

CONCLUSIONS

Ameliorating PTSD can reduce risk of suicide mortality, but patients must achieve symptomatic remission to attain this benefit.

Introduction to the Special Issue on Posttraumatic Stress and Suicide

This article introduces this special issue of the Journal of Traumatic Stress devoted to new research investigating the associations among trauma exposure, posttraumatic stress symptoms, and suicidal ideation and behavior. Given the high rates of suicide seen in the aftermath of trauma exposure around the globe, it is important that researchers and clinicians strive to better understand the underlying processes and mechanisms that account for this association and that potentially could be harnessed in intervention and prevention efforts. This opening article introduces the content and themes of the present collection of manuscripts gathered together in this special issue, which includes both conceptual and empirical pieces devoted to the study of suicidality in the context of trauma exposure and considers implications for future research and evidence-based interventions.

Commentary on the Special Issue on Posttraumatic Stress and Suicide: Recognizing that simple things save lives

This article offers commentary on the special issue of the Journal of Traumatic Stress dedicated to posttraumatic stress and suicide, with a specific focus on practical recommendations that can be integrated into day-to-day clinical practice. Given the complexity of the myriad associations among posttraumatic stress symptoms, the nature of trauma, and suicidality demonstrated in the articles in this issue, it is important for practitioners to utilize evidence-based approaches to clinical practice in order to be effective. The articles in this special issue offer findings that do just that, providing a foundation rich in practical applications to clinical work, including an understanding of potential mechanisms of action and related targeted interventions.