@article{ref1,
title="Suicide risk in people with post-traumatic stress disorder: a cohort study of 3.1 million people in Sweden",
journal="Journal of affective disorders",
year="2020",
author="Fox, Verity and Dalman, Christina and Dal, Henrik and Hollander, Anna-Clara and Kirkbride, James B. and Pitman, Alexandra",
volume="279",
number="",
pages="609-616",
abstract="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. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="0165-0327",
doi="10.1016/j.jad.2020.10.009",
url="http://dx.doi.org/10.1016/j.jad.2020.10.009"
}