Suicidal behavior in posttraumatic stress disorder: Focus on combat exposure

Data in veterans and active personnel has revealed a robust association between combat trauma, posttraumatic stress disorder (PTSD), and suicidal behavior, a concerning relationship considering the highly traumatic nature of combat action. Additionally, mood, anxiety, substance abuse, and personality disorders are frequently comorbid with the diagnosis of PTSD and can synergistically or additively elevate the risk of suicide in the military as well as civilian patients already struggling with this disorder. The relationship between PTSD and suicidal behavior is even further complicated by the fact that some studies implicate traumatic experience and not symptoms of PTSD in the elevated risk of suicidal behavior observed in this patient population. More longitudinal studies are needed in order to evaluate the temporal relationship between the traumatic events and the clinical manifestations of PTSD, in order to disentangle this convoluted relationship. Once the mechanisms of trauma-driven suicidal behavior are better understood, improved therapeutic modalities and reduction of suicidal behavior in veterans as well as civilians struggling with PTSD and co-occurring psychiatric disorders should follow.