High Stress, Trauma-Prone Lives, and Suicide Risk

Joel Yager, MD reviewing Gradus JL et al. Am J Epidemiol 2015 Aug 4.

Individuals with stress disorders are more likely to experience subsequent traumas, snowballing into higher rates of psychiatric diagnoses, all-cause mortality, and suicide.

Although several studies suggest that stress disorders, particularly post-traumatic stress disorder (PTSD), are associated with increased risk for psychiatric morbidity, mortality, and suicide, few large-scale epidemiological surveys have examined these phenomena. Using Danish registry data on 101,663 citizens diagnosed with acute stress reaction (9%), adjustment disorder (66%), PTSD (4%), or other reactions to severe stress (22%) from 1995 through 2011, researchers examined all subsequent inpatient and outpatient records coded for four types of traumatic events, psychiatric diagnoses, mortality, and suicide.

Compared with 508,315 age- and sex-matched individuals without stress diagnoses, individuals with initial stress disorders had substantially higher rates during the 15-year follow-up of accidents, assaults, poisonings, and maltreatment syndromes and of new incident depressive, anxiety, alcohol, and substance use disorders. Analyses were adjusted for baseline depression, anxiety, and alcohol and substance abuse/dependence and for physical comorbidities. All-cause mortality was significantly higher with acute stress reaction (rate ratio [RR], 2.2), adjustment disorders (RR, 1.9), PTSD (RR, 1.8), and other reactions to severe stress (RRs, 2.0–2.2). Suicide rates were substantially elevated with acute stress reaction (RR, 24), adjustment disorders (RR, 12), PTSD (RR, 13), and other reactions to severe stress (RRs, 19–29).

Citation(s):

Gradus JL et al. Trauma, comorbidity, and mortality following diagnoses of severe stress and adjustment disorders: A nationwide cohort study. Am J Epidemiol 2015 Aug 4; [e-pub].