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Sala-Hamrick KJ, Braciszewski JM, Yeh HH, Zelenak L, Westphal J, Beebani G, Frank C, Simon GE, Owen-Smith AA, Rossom RC, Lynch F, Lu CY, Waring SC, Harry ML, Beck A, Daida YG, Ahmedani BK. Diagnosed Posttraumatic Stress Disorder and Other Trauma-Associated Stress Disorders and Risk for Suicide Mortality. Psychiatr Serv 2023; 74:936-942. [PMID: 37143334 PMCID: PMC10497061 DOI: 10.1176/appi.ps.202100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Strong evidence exists for posttraumatic stress disorder (PTSD) as a risk factor for suicidal thoughts and behaviors across diverse populations. However, few empirical studies have examined PTSD and other trauma-associated stress disorders as risk factors for suicide mortality among health system populations. This study aimed to assess trauma-associated stress diagnoses as risk factors for suicide mortality in a U.S. health system population. METHODS This case-control, matched-design study examined individuals who died by suicide between 2000 and 2015 and had received care from nine U.S. health systems affiliated with the Mental Health Research Network (N=3,330). Individuals who died by suicide were matched with individuals from the general health system population (N=333,000): 120 individuals with PTSD who died by suicide were matched with 1,592 control group members, 84 with acute reaction to stress were matched with 2,218 control individuals, and 331 with other stress reactions were matched with 8,174 control individuals. RESULTS After analyses were adjusted for age and sex, individuals with any trauma-associated stress condition were more likely to have died by suicide. Risk was highest among individuals with PTSD (adjusted OR [AOR]=10.10, 95% CI=8.31-12.27), followed by those with other stress reactions (AOR=5.38, 95% CI=4.78-6.06) and those with acute reaction to stress (AOR=4.49, 95% CI=3.58-5.62). Patterns of risk remained the same when the analyses were adjusted for any comorbid psychiatric condition. CONCLUSIONS All trauma-associated stress disorders are risk factors for suicide mortality, highlighting the importance of health system suicide prevention protocols that consider the full spectrum of traumatic stress diagnoses.
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Affiliation(s)
- Kelsey J Sala-Hamrick
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Hsueh-Han Yeh
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Logan Zelenak
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Joslyn Westphal
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Ganj Beebani
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Cathrine Frank
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Gregory E Simon
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Ashli A Owen-Smith
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Rebecca C Rossom
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Frances Lynch
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Christine Y Lu
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Stephen C Waring
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Melissa L Harry
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Arne Beck
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Yihe G Daida
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
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