Abstract
Objective: The association between posttraumatic stress disorder (PTSD) and suicidal ideation (SI) is well-known. However, a few studies have investigated the associations between PTSD symptom clusters based on the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) and changes in suicide risk longitudinally.Methods: We adopted a longitudinal study design using data from the National Survey for Stress and Health of 3,090 of the Japanese population. The first and second surveys were conducted on November 2016 and March 2017, respectively. The suicidal ideation attributes scale was applied to assess the severity of suicidal ideation at baseline and the follow-up period. A multivariate linear regression model was conducted to examine the associations between the 4- or 7-factor model of PTSD symptom clusters at baseline and longitudinal changes in SI.Results: Overall, 3,090 subjects were analyzed (mean age, 44.9 ± 10.9 years; 48.8% female) at Baseline, and 2,163 completed the second survey. In the 4-factor model, we found that the severity of negative alternations in cognition and mood were significantly associated with increased SI after 4 months. In the 7-factor model, we found that the severity of anhedonia and externalizing behavior at baseline was significantly associated with increased SI during the follow-up period.Conclusions: We found that the seven-factor model of DSM-5 PTSD symptoms may provide greater specificity in predicting longitudinal SI change in the general population. Closely monitoring specific PTSD core symptoms may be more effective in mitigating key clinical and functional outcomes.
Highlights
According to the World Health Organization report, the crude suicide rate is estimated at 9.0 per 100,000 of the populations worldwide, with the highest at 16.1 in the United States of America (USA) [1]
A DSM-5 diagnostic status based on the PTSD checklist (PCL)-5 was obtained and showed that posttraumatic stress disorder (PTSD) (50%) was the most common diagnosis, followed by trauma experienced without PTSD (30.1%), and no trauma experienced (16.7%)
After multiple linear regression analysis, we found an history of physical abuse [beta = 1.16, 95% confidence interval = 0.34–1.97, and p = 0.005], previous suicide attempt, comorbid with diagnosis of major depressive disorder (MDD), and NACM symptoms based on the DSM-5 four-factor model were significantly associated with an increased Suicidal Ideation Attributes Scale (SIDAS) score (Table 3)
Summary
According to the World Health Organization report, the crude suicide rate is estimated at 9.0 per 100,000 of the populations worldwide, with the highest at 16.1 in the United States of America (USA) [1]. PTSD has been reorganized into four clusters: intrusion symptoms, avoidance, negative alternations in cognition and mood (NCAM), and alterations in arousal and reactivity (AAR) based on the Diagnostic and Statistical Manual of Mental Disorder (DSM-5) [6]. Several confirmatory factor analysis (CFA) studies, in contrast to the four-factor model, have found that the best-fitting model is a seven-factor model, which includes intrusion symptoms, Abbreviations: PTSD, posttraumatic stress disorder; SI, suicidal ideation; DSM5, Diagnostic and Statistical Manual for Mental Disorders; NCAM, negative alternations in cognition and mood; AAR, alterations in arousal and reactivity; PCL, PTSD checklist; CFA, confirmatory factor analysis; MDD, major depressive disorder; OCD, obsessive compulsive disorder; SAD, seasonal affective disorder; PAD, panic disorder; GAD, generalized anxiety disorder; NSSH, National Survey for Stress and Health; WHO-CIDI, World Health Organization Composite International Diagnostic Interview, version 3.0; SIDAS, Suicidal Ideation Attributes Scale
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