Suicidality in patients with post-traumatic stress disorder and its association with receipt of specific secondary mental healthcare treatments

Elena Opie, Nomi Werbeloff, Joseph Hayes, David Osborn, Alexandra Pitman

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Post-traumatic stress disorder (PTSD) is a risk factor for suicidality (suicidal ideation, and suicide attempt). This study described the prevalence of suicidality amongst a representative sample of individuals with PTSD and the association between suicidality and receipt of five PTSD treatments. Methods: We analysed deidentified data for patients being treated for PTSD at Camden and Islington NHS Foundation Trust between 2009 and 2017 obtained via the Clinical Record Interactive Search tool. We described the sample’s sociodemographic and clinical characteristics and used stepwise logistic regression to investigate the association between suicidality and receipt of four, specific PTSD treatments: psychotherapy, antidepressant/antianxiety medication, antipsychotics, benzodiazepines. We used Cox proportional hazards regression to investigate the association between suicidality and hospital/crisis team admission. Results: Of 745 patients diagnosed with PTSD, 60% received psychotherapy and 66% received psychotropic medication. Those who reported suicidality (6%) were no more likely than those who did not to be prescribed antidepressant/antianxiety medication, but were more likely to receive antipsychotics (AOR = 2.27, 95% CI 1.15 − 4.47), benzodiazepines (AOR 2.28, 95% CI 1.17 − 4.44), psychotherapy (AOR 2.60, 95% CI 1.18 − 5.73) and to be admitted to hospital/crisis team (AOR 2.84, 95% 1.82 − 4.45). Conclusion: In this sample, patients with PTSD and suicidality were more likely to receive psychiatric medication, psychotherapy and psychiatric admission than those who were not suicidal. Overall patients were more likely to receive psychotropic medication than psychotherapy. Adherence to clinical guidelines is important in this population to improve treatment outcomes and reduce the risk of suicide.KEY POINTS NICE guidelines recommend psychological therapy be first line treatment for PTSD, yet we identified that fewer people diagnosed with PTSD received therapy compared to psychotropic medication. Patients with suicidality were more likely to receive antipsychotics and benzodiazepines, yet not antidepressant/antianxiety medication although given that suicidality is characteristic of severe depression, it might be assumed from stepped care models that antidepressant/antianxiety medication be prescribed before antipsychotics. The high proportion of patients prescribed antipsychotics suggests a need for better understanding of psychosis symptoms among trauma-exposed populations. Identifying which combinations of symptoms are associated with suicidal thoughts could help tailor trauma-informed approaches to discussing therapy and medication.

Original languageEnglish
Pages (from-to)151-160
Number of pages10
JournalInternational Journal of Psychiatry in Clinical Practice
Volume27
Issue number2
Early online date11 Nov 2022
DOIs
StatePublished - Jun 2023

Bibliographical note

Publisher Copyright:
© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Funding

CRIS is supported by the Noclor Joint NHS Research Office and the National Institute for Health Research (NIHR) University College London Hospital Biomedical Research Centre (BRC). J.H., D.O. and A.P. are supported by the University College London Hospitals (UCLH) National Institute of Health Research (NIHR) Biomedical Research Centre (BRC). D.O. was also part-supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Bart’s Health NHS Trust.

FundersFunder number
National Institute for Health and Care Research
UCLH Biomedical Research Centre
Collaboration for Leadership in Applied Health Research and Care - Greater Manchester
University College London Hospitals Biomedical Research Centre
NIHR Imperial Biomedical Research Centre

    Keywords

    • Post-traumatic stress disorder
    • clinical guidelines
    • psychiatric admission
    • psychopharmacology
    • psychotherapy
    • suicide

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