Suicide risk in people with post-traumatic stress disorder: A cohort study of 3.1 million people in Sweden

JOURNAL OF AFFECTIVE DISORDERS

卷:279

Article

Fox, Verity¹  Dalman, Christina^2,3  Dal, Henrik²  Hollander, Anna-Clara²  Kirkbride, James B.¹  Pitman, Alexandra^1,4 

[1] UCL, Div Psychiat, London W1T 7NF, England

[2] Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden

[3] Ctr Epidemiol & Social Med, Stockholm, Sweden

[4] Camden & Islington NHS Fdn Trust, London NW1 0PE, England

关键词: Suicide;    Post-traumatic stress disorder;    PTSD;    Epidemiology;    Cohort study;   

DOI  :  10.1016/j.jad.2020.10.009

来源: Elsevier

【 摘 要 】

Background: It is unclear whether post-traumatic stress disorder [PTSD] is associated with suicide risk in the general population, whether this differs by sex, or what the population impact of PTSD is for suicide. Methods: We constructed a nationwide cohort of all people living in Sweden, born 1973-1997, followed from their 14th birthday (or immigration, if later) until suicide, other death, emigration or 31 December 2016. We used Cox proportional hazards regression to estimate hazard ratios [HR], and calculated the population impact of PTSD on suicide. We included sensitivity analyses to explore effects of outcome and exposure definitions, and to account for potential competing risks. Results: Of 3,177,706 participants, 22,361 (0.7%) were diagnosed with PTSD, and 6,319 (0.2%) died by suicide over 49.2 million person-years. Compared with women and men without PTSD, suicide rates were 6.74 (95%CI: 5.61-8.09) and 3.96 (95%CI: 3.12-5.03) times higher in those with PTSD, respectively, after sociodemographic adjustment. Suicide rates remained elevated in women (HR: 2.61; 95%CI: 2.16-3.14) and men (HR: 1.67; 95%CI: 1.31-2.12) after adjustment for previous psychiatric conditions; attenuation was driven by previous non-fatal suicide attempts. Findings were insensitive to definitions or competing risks. If causal, 1.6% (95%CI: 1.2-2.1) of general population suicides could be attributed to PTSD, and up to 53.7% (95%CI: 46.1-60.2) in people with PTSD. Limitations: Residual confounding remains possible due to depressive and anxiety disorders diagnosed in primary care but unrecorded in these registers. Conclusions: Clinical guidelines for the management of people with PTSD should recognise increased suicide risks.

【 授权许可】

Free