Abstract
BackgroundThe literature on the association between Posttraumatic Stress Disorder (PTSD) and fatal and non-fatal intentional self-harm (ISH) among Veterans who receive care within the Veterans Health Administration (VHA) is limited in scope and contradictory. The current study examines the association between PTSD and non-fatal ISH in a gender-stratified sample of patients who received care at a Massachusetts VHA treatment facility between 2000 and 2008.MethodsVHA electronic medical record data were obtained for patients who received a PTSD diagnosis at a Massachusetts treatment facility (n = 16,004) and a gender/age matched comparison group (n = 52,502). Rate ratios for the association between PTSD and non-fatal ISH were computed adjusting for marital status, depression, alcohol or drug abuse or dependence, anxiety disorder diagnoses and prior ISH and clustering by hospital using Poisson regression. The interaction between PTSD and depression diagnoses in predicting non-fatal ISH was assessed as the departure from additive effects by calculating the interaction contrast (IC) while adjusting for identified confounders.ResultsOver the eight year study period 146 (0.91%) of those with PTSD experienced non-fatal ISH, while 71 (0.14%) of those without PTSD experienced non-fatal ISH. Strong adjusted associations between PTSD and non-fatal ISH were found for both male (RR = 3.3, 95% CI = 2.3, 4.6) and female (RR = 16, 95% CI = 4.7, 55) VHA patients. Evidence of an interaction between PTSD and depression diagnoses in predicting non-fatal ISH was found as a departure from additive effects for both sexes, but this association was more marked among women than among men.ConclusionsOur results indicate that non-fatal ISH among women may be more strongly related to PTSD than prior work focusing on suicide has suggested and highlight the importance of gender-stratified examinations of these associations. Further, our results suggest that suicide prevention approaches in the VHA should integrate treatment for PTSD and depression.
Highlights
The literature on the association between Posttraumatic Stress Disorder (PTSD) and fatal and non-fatal intentional self-harm (ISH) among Veterans who receive care within the Veterans Health Administration (VHA) is limited in scope and contradictory
One small study found that male VHA patients in residential treatment for PTSD were four times as likely to die by suicide as were age and sex-matched members of the general population (Drescher et al 2003)
The most recent and largest study of VHA patients, and the only study to stratify by sex, found that among VHA patients diagnosed with PTSD in 1999, males were 1.8 times as likely and females were 3.5 times as likely to die by suicide in the seven years that followed than were patients without a PTSD diagnosis, while adjusting for age but not other potential confounders such as psychiatric comorbidity (Ilgen et al 2010)
Summary
VHA electronic medical record data were obtained for patients who received a PTSD diagnosis at a Massachusetts treatment facility (n = 16,004) and a gender/age matched comparison group (n = 52,502). Rate ratios for the association between PTSD and non-fatal ISH were computed adjusting for marital status, depression, alcohol or drug abuse or dependence, anxiety disorder diagnoses and prior ISH and clustering by hospital using Poisson regression. The records of patients who received a PTSD diagnosis (ICD-9-CM code 309.81) at a Massachusetts VHA treatment facility between fiscal years 2000 and 2008 were obtained from the electronic medical record (n = 16,004). A comparison cohort of veterans who received care at a Massachusetts VHA treatment facility, but who never received a PTSD diagnosis, were matched to PTSD patients, with a ratio of up to 5 to 1, on five-year age categories and gender (n = 52,502). Data were obtained for the following variables during the study period: depression diagnoses (ICD-9-CM codes: 296.2-296.3), substance use disorders (ICD-9-CM codes: 303.xx-305.9), anxiety disorders (ICD9-CM codes: 300, 300.01-300.02), and ISH resulting in an inpatient hospitalization (ICD-9-CM codes: E950-E959)
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