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Event-related PTSD symptoms as a high-risk factor for suicide: longitudinal observational study

Nature Mental Health volume 1, pages 1013–1022 (2023)Cite this article

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Abstract

There is long-standing controversy as to whether suicide risk in those who have survived a traumatic event is highest when the severity of the survivors’ psychiatric condition is worst or when they begin to recover. To tackle this problem, we extracted psychiatric conditions from an online cohort of Japanese participants during the COVID-19 pandemic, at five time points (T1–T5). For 12,578 responses from 3,815 participants (mean age 47.1 years; 46.8% women), 3,508 psychiatric conditions were extracted in T1, 2,680 in T2, 2,562 in T3, 2,022 in T4 and 1,806 in T5. We then investigated whether extracted conditions could predict suicide rates in the full Japanese population in a time-specific manner. We found that COVID-19-related PTSD symptoms are associated with increased suicide rates (P = 3.0 × 10−6, Bayesian information criterion (BIC) = −23.69), and are of greater concern than depression (P = 7.6 × 10−4, BIC = −13.19) and anxiety symptoms (P = 5.9 × 10−3, BIC = −9.35). Furthermore, associations of psychiatric states with increased suicide rates are time specific (P = 0.011), suggesting that a population shows higher suicide risk when symptom severity is high. Event-related PTSD symptoms may help to identify groups at high risk of suicide and improve prevention policies.

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Fig. 1: The study population.
Fig. 2: Comparison of models that test associations between psychiatric states and increases in suicide rate.
Fig. 3: Association between the estimated suicide risk, based on COVID-19-related PTSD symptoms, and the actual suicide rate.
Fig. 4: Cross-lagged association between the estimated increase in suicide rate and the actual increase.

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Data availability

The main summary statistics that support the findings of this study are available in the Supplementary Information. Owing to company cohort data-sharing restrictions, individual data cannot be publicly posted. However, data are available from the corresponding authors upon request and with permission of KDDI Corporation. Data requests should be sent to the corresponding authors and will be responded to within 21 days.

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Acknowledgements

This research was supported by a KDDI collaborative research contract (T.C., K.I., M.M., T.O., F.N., R.Y., T. Kubo, M.K. and A.C.). This work was also supported by the Innovative Science and Technology Initiative for Security grant number JPJ004596, ATLA (M.M., R.Y., M.K. and A.C.), the Ikegaya Brain-AI Hybrid ERATO grant (JPMJER1801) from the Japan Science and Technology Agency (T.O., T. Kubo, M.K. and A.C.) and AMED under grant number JP20dm0307008 (M.M., T.O., R.Y. and A.C.). We thank M. Nagata for data collection and organization. Beyond employment, the funder had no direct role in the study design, data collection and analysis, decision to publish or preparation of the article.

Author information

Author notes

  1. These authors contributed equally: Toshinori Chiba, Kentarou Ide.

Authors and Affiliations

  1. The Department of Decoded Neurofeedback, Computational Neuroscience Laboratories, Advanced Telecommunications Research Institute International, Kyoto, Japan

    Toshinori Chiba, Kentarou Ide, Misa Murakami, Taiki Oka, Rumi Yorizawa, Takatomi Kubo, Mitsuo Kawato & Aurelio Cortese

  2. The Department of Psychiatry, Self-Defense Forces Hanshin Hospital, Kawanishi, Japan

    Toshinori Chiba

  3. National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan

    Toshinori Chiba

  4. Seven-Mental Clinic, Osaka, Japan

    Kentarou Ide

  5. Life Science Laboratories, KDDI Research, Inc., Tokyo, Japan

    Nao Kobayashi, Yuka Miyake, Toshitaka Hamamura & Masaru Honjo

  6. Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan

    Taiki Oka & Shuken Boku

  7. Department of Clinical Psychology, Graduate School of Human Sciences, Osaka University, Suita, Japan

    Taiki Oka

  8. The Department of Computational Brain Imaging, Computational Neuroscience Laboratories, Advanced Telecommunications Research Institute International, Kyoto, Japan

    Fumiya Nakai

  9. Mathematical Informatics Laboratory, Nara Institute of Science and Technology (NAIST), Kyoto, Japan

    Fumiya Nakai & Takatomi Kubo

  10. College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia

    Toshitaka Hamamura

  11. The Department of Psychiatry, National Defense Medical College, Tokorozawa, Japan

    Hiroyuki Toda

  12. The Department of Neuropsychiatry, Osaka Medical College, Osaka, Japan

    Tetsufumi Kanazawa

  13. Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan

    Akitoyo Hishimoto

  14. Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Akitoyo Hishimoto

  15. XNef, Kyoto, Japan

    Mitsuo Kawato

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Contributions

T.C., K.I. and A.C. contributed to study conception and design. T.C., N.K., T.O., Y.M., T.H. and M.H. contributed to data acquisition. T.C., M.M., T.O., F.N., R.Y., T. Kubo and A.C. conducted statistical analyses. T.C., K.I., T.O., H.T., T. Kanazawa, S.B., T. Kubo, A.H., M.K. and A.C. contributed to interpretation of data. T.C., K.I. and M.M. drafted the first version of the article. T.C., M.M., T.O., N.K. and A.C. had full access to the data. All authors revised and approved the final version of the article. T.C. and A.C. take responsibility for the integrity of the work.

Corresponding authors

Correspondence to Toshinori Chiba or Aurelio Cortese.

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Competing interests

N.K., Y.M., T.H. and M.H. are employees of KDDI Research. The other authors declare no competing interests.

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Nature Mental Health thanks Stuart Leske, Jennifer Stevens and the other, anonymous reviewer(s) for their contribution to the peer review of this work.

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Supplementary Figs. 1–5 and Tables 1 and 2.

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Chiba, T., Ide, K., Murakami, M. et al. Event-related PTSD symptoms as a high-risk factor for suicide: longitudinal observational study. Nat. Mental Health 1, 1013–1022 (2023). https://doi.org/10.1038/s44220-023-00157-2

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