Posttraumatic stress disorder, depression, and suicide in veterans
ABSTRACTSuicidal behavior is a critical problem in war veterans. Combat veterans are not only more likely to have suicidal ideation, often associated with posttraumatic stress disorder (PTSD) and depression, but they are more likely to act on a suicidal plan. Especially since veterans may be less likely to seek help from a mental health professional, non-mental-health physicians are in a key position to screen for PTSD, depression, and suicidal ideation in these patients. The authors discuss the association of PTSD, depression, and suicide in veterans, keys to assessment of suicide risk, and interventions.
KEY POINTS
- The association of suicidal ideation with PTSD and depression and the prevalence of these conditions in combat veterans underline the importance of recognizing and treating these conditions.
- In veterans with PTSD related to combat experience, combat-related guilt may be a significant predictor of suicidal ideation and attempts.
- Research addressing PTSD, depression, and suicidal behavior in war veterans is critically needed to improve our understanding of the nature of these conditions and how best to treat them.
INTERVENTIONS
Patients with comorbid depression, PTSD, and suicidal ideation are usually very sick and should be referred to a psychiatrist. They are usually treated with antidepressants, such as paroxetine (Paxil) or sertraline (Zoloft), and psychotherapy.65 Patients who have a suicidal intent or a plan should be referred to an emergency department for evaluation or hospitalization. All veterans should be given the toll-free phone number of the Veterans Crisis Line (1-800-273-8255), a US Department of Veterans Affairs (VA) resource that connects veterans in crisis and their families and friends, with qualified VA professionals.
As with many illnesses, such as cancer, suicidal behavior is most treatable and yields the best outcome when diagnosed and treated early.66 And the earliest manifestation of suicidal behavior is suicidal ideation.
The association of suicidal ideation with PTSD and depression underlines the importance of the timely diagnosis and effective treatment of these conditions among war veterans. Veterans experiencing subthreshold PTSD or depression may be less likely to receive mental health treatment. This indicates that non-mental-health clinicians should be educated about how to detect PTSD and depression symptoms. They may also help to detect suicidality early, which may help save lives.
Promoting social, emotional, and spiritual wellness
Our patients remind us every day that the work we do matters, that we have much more to learn, and that the more we understand suicidal behavior in veterans, the more we can do to reduce their suffering. We need to promote their social, emotional, and spiritual wellness. Encouraging resilience, optimism, and mental health can protect them from depression, suicidal ideation and behavior. Resilience can be promoted by teaching patients to:
- Build relationships with family members and friends who can provide support
- Think well about themselves and identify their areas of strength
- Invest time and energy in developing new skills
- Challenge negative thoughts; try to find optimistic ways of viewing any situation
- Look after their physical health and exercise regularly
- Get involved in community activities to help counter feelings of isolation
- Ask for assistance and support when they need it.67
Our knowledge about what works and what does not work in suicide prevention in veterans is evolving. Research addressing combat-related PTSD, depression, and suicidal behavior in war veterans is critically needed to better understand the nature of these conditions.
