I've got an old psychiatry textbook for medical students, written by a professor at Harvard Medical School named Robert J. Waldinger, M.D., and it's been interesting leafing through it and finding out what it has to say about PTSD (not much) and suicide (quite a lot). The edition I have is the second edition (a third edition is in print), and it goes back almost 20 years, to 1990. PTSD is covered in less than a page, but suicide has quite a bit of coverage, and much of what it says is interesting.
For example:
"A majority (60-80%) of people who commit suicide carry a diagnosis of depression. Estimates of the risk of suicide in all mood disorders are as high as 15%, with the greatest period of risk within 5 years after the onset of the disorder. The risk of suicide among people with mood disorders is 30 times that of the general population."
There's also this longer passage about who's most at risk for suicide. The passage was written based on data that was available at the time -- 1990 -- and some of the percentages have changed up or down since then. However, as you read these factors, think about how many of them might be in play for combat veterans, in light of the recent rise in veteran suicides. Our observation? Quite a few. See if you don't agree:
"Suicidologists have long searched for "suicide profiles." They have looked at everything from the phases of the moon to birth order in the family in an effort to solve the mystery of why certain people resort to suicide. The following are the risk factors most consistently identified in recent studies:
- Age- The risk of suicide ... is greatest for nonwhite males in their 20s and 30s, and rises again (in the elderly). Nonwhite females have the highest suicide rate in young adulthood to age 40, with a decline thereafter. In the last 25 years there has been a more than three-fold increase in the rate of suicide among adolescents and young adults (and this figure has only gone up);
- Sex - Men commit suicide three times more frequently than women. However, women attempt suicide two to three times as often as men. Men tend to use knives, firearms and other violent means of suicide, while women show a preference for self-poisoning;
- Race - The suicide rate is higher for whites than nonwhites. However the rate among young black adults in ghetto areas has recently increased sharply;
- Marital status - Suicide rates are lowest for married people and higher for those who are separated, divorced, or widowed;
- Living situation - People who live alone are at a higher risk of suicide than people who live with others;
- Employment status - People who are unemployed are at a higher risk of suicide than those who are working in or out of the home ...;
- Physical health - Physical illness, or the perception that one is ill, is more frequent among those who commit suicide. In particular, there is a high correlation between completed suicide and visits to a physician for medical complaints during the preceding six (6) months. The risk of suicide is significantly increased among people suffering from cancer and AIDS;
- Mental health- Among the mental illnesses that have been correlated with a high risk of suicide are depression, manic-depressive illness (bipolar disorder), and schizophrenia. Non-fatal attempts are more prevalent among people with personality disorders, and adjustment disorders. In general, the presence of major mental illness should alert the clinician to the possibility of suicide. More than 90% of adults who commit suicide have an associated psychiatric illness;
- Alcohol abuse or addiction - Alcoholism markedly increases the risk of suicide;
- Previous suicide attempts - A history of suicide attempts has been estimated to increase the risk of completed suicide by as much as 64 times that of the general population. At least 10% of suicide attempters eventually kill themselves;
The following factors, while less easily quantifiable, have also been associated with completed suicides:
- Hopelessness - Several studies have concluded that the specific symptom of hopelessness about one's life situation is more highly correlated with suicide than is the more general category of depression;
- Interpersonal loss- There is a high correlation between interpersonal loss and suicide. Loss is defined as the separation from, divorce from, or death of a significant other, and may include relatives, friends, lovers, and therapists. The risk of suicide is particularly high among alcoholic individuals who have suffered major interpersonal losses within the previous six (6) weeks;
- Life stresses - A high frequency of major life events in the previous six (6) months has been found among those who commit suicide. Such events include job changes, moves, births, graduations, financial reversals, marriage, retirement and menopause. Such changes are important to identify in assessing both the precipitants of a suicidal crises and the possibilities for therapeutic intervention;
- Interpersonal conflict - Long-standing intense interpersonal conflict with family members or other important people is associated with a high risk of suicide and has led some observers to characterize suicide as a fundamentally dyadic [definition] event. Such conflict, if unremitting, may continue to jeopardize the life of the patient after a particular crisis has passed. "
Source: Psychiatry for Medical Students, Second Edition, by Robert J. Waldinger, M.D. (Instructor in Psychiatry, Harvard Medical School, Director of Training, Massachusetts Mental Health Center, Boston, Massachusetts.) Washington, DC: American Psychiatric Press, Inc. (1990).
