Positive result on PTSD screen linked to 58% increase in veteran suicide mortality risk

Positive results on the Primary Care-Posttraumatic Stress Disorder Screen were associated with an increased risk for suicide mortality among veterans, according to study results published in JAMA Network Open.

“Previous studies have typically relied on PTSD diagnoses reported in medical records; however, patients may experience clinically important PTSD symptoms without receiving a diagnosis, and PTSD symptoms may fluctuate over time,” Samantha A. Cooper, MPH, of the Office of Mental Health and Suicide Prevention at the Department of Veterans Affairs, and colleagues wrote. “Therefore, it may be informative to evaluate the suicide mortality risk associated with self-reported PTSD symptoms among veterans without an established PTSD diagnosis. Recent studies have identified positive associations between PTSD symptoms and both suicidal ideation and suicidal behaviors; however, to our knowledge, no study has examined whether veteran-reported PTSD symptoms are associated with the risk [for] suicide mortality.”

For its annual PTSD screening, the U.S. Veterans Health Administration (VHA) uses the Primary Care-PTSD (PC-PTSD) screen. In the current study, Cooper and colleagues sought to determine whether positive results on the screen among veterans receiving care in the VHA were linked to increased risk for suicide mortality vs. veterans with negative results, as well as evaluate whether this risk decreased over time. They used multivariable proportional hazards regression models to analyze data of 1,552,581 veterans who completed 1,693,449 PC-PTSD screens. The screen included four questions related to PTSD symptoms, with each yes representing a positive answer, and a score of three or four indicated an overall positive result. Most participants were white (73.9%), married (52.2%), men (91.1%), aged 55 years or older (62.5%) and had completed only one screening (92.1%).

Multivariable analyses revealed an association between positive PC-PTSD results and a 58% increased risk for suicide mortality 1 day after screening (HR = 1.58; 95% CI, 1.19-2.1), as well as a 26% increased risk for suicide mortality 1 year after screening (HR = 1.26; 95% CI, 1.07-1.48). Those who responded positively to feeling numb or detached from others, activities or their surroundings exhibited a 70% increased suicide mortality risk 1 day after screening (HR = 1.7; 95% CI, 1.27-2.28).

“The PC-PTSD may identify distinct risks that are not identified by other assessment procedures used in the VHA or other health systems,” Cooper and colleagues wrote.