Posttraumatic stress disorder increases risk for suicide attempt in adults with recurrent major depression

Daniel Stevens, Holly C. Wilcox, Dean F. Mackinnon, Francis M Mondimore, Barbara Schweizer, Dunya Jancic, William H. Coryell, Myrna M. Weissman, Douglas F. Levinson, James B. Potash

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Background Genetics of Recurrent Early-Onset Depression study (GenRED II) data were used to examine the relationship between posttraumatic stress disorder (PTSD) and attempted suicide in a population of 1,433 individuals with recurrent early-onset major depressive disorder (MDD). We tested the hypothesis that PTSD resulting from assaultive trauma increases risk for attempted suicide among individuals with recurrent MDD. Methods Data on lifetime trauma exposures and clinical symptoms were collected using the Diagnostic Interview for Genetic Studies version 3.0 and best estimate diagnoses of MDD, PTSD, and other DSM-IV Axis I disorders were reported with best estimated age of onset. Results The lifetime prevalence of suicide attempt in this sample was 28%. Lifetime PTSD was diagnosed in 205 (14.3%) participants. We used discrete time-survival analyses to take into account timing in the PTSD-suicide attempt relationship while adjusting for demographic variables (gender, race, age, and education level) and comorbid diagnoses prior to trauma exposure. PTSD was an independent predictor of subsequent suicide attempt (HR = 2.5, 95% CI: 1.6, 3.8; P <.0001). Neither assaultive nor nonassaultive trauma without PTSD significantly predicted subsequent suicide attempt after Bonferroni correction. The association between PTSD and subsequent suicide attempt was driven by traumatic events involving assaultive violence (HR = 1.7, 95% CI: 1.3, 2.2; P<.0001). Conclusions Among those with recurrent MDD, PTSD appears to be a vulnerability marker of maladaptive responses to traumatic events and an independent risk factor for attempted suicide. Additional studies examining differences between those with and without PTSD on biological measures might shed light on this potential vulnerability.

Original languageEnglish (US)
Pages (from-to)940-946
Number of pages7
JournalDepression and anxiety
Issue number10
StatePublished - Oct 2013


  • PTSD/posttraumatic stress disorder
  • anxiety/anxiety disorders
  • depression
  • suicide/self harm
  • trauma

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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