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Cited by 39Suicide and Self-Harm StudiesPosttraumatic Stress Disorder ResearchGrief, Bereavement, and Mental Health

Ptsd from a suicide attempt: an empirical investigation among suicide attempt survivors

Open access
Stanley, Ian H., Hom, Melanie A., Boffa, Joseph W., Stage, Dese'Rae L., Joiner, Thomas E.·2019·Journal of Clinical Psychology
DOI 10.1002/jclp.22833PMC PMC6744326
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Abstract

Objectives: Suicide attempts (SAs), by definition, represent a risk for serious injury or death; thus, one's SA may contribute to the development of posttraumatic stress disorder (PTSD). Yet, empirical data on this topic are lacking. This study aimed to characterize the phenomenology, rate, and associated features of PTSD following one's SA. Method: A total of 386 adult SA survivors recruited from web‐based sources participated. Results: Overall, 27.5% (95% confidence interval = 23.1–31.9%) of SA survivors screened positive for a probable SA‐related PTSD diagnosis. Individuals with a probable SA‐related PTSD diagnosis reported greater current suicidal intent than those without this probable diagnosis; this association was significant at low, but not high, levels of depression symptoms. Conclusions: A substantial proportion of SA survivors may experience SA‐related PTSD. SA‐related PTSD may be a viable assessment and intervention target to improve the quality of life and to reduce future suicide risk among SA survivors.

AI snapshot

Written from the paper’s full text.

TL;DR

Among 386 adult suicide attempt survivors recruited online, 27.5% screened positive for probable suicide attempt-related PTSD. Those with probable attempt-related PTSD reported higher current suicidal intent, but this association was significant only at low levels of depression symptoms.

Key findings

  • Overall, 27.5% (95% CI = 23.1%–31.9%; n = 106/386) met DSM-5 algorithm criteria for probable suicide attempt-related PTSD; symptom-cluster rates were 45.6% for intrusions, 40.9% for avoidance, 67.4% for negative alterations in cognitions and mood, and 59.8% for hyperarousal.
  • Participants whose most lethal attempt occurred in the past year were more likely to screen positive than those whose attempt was over a year ago (44.9% vs. 24.9%; χ²[1] = 8.566, p = .003), and those with probable attempt-related PTSD reported using more suicide methods during their most lethal attempt (M = 1.76 vs. 1.45; F[1, 384] = 10.318, p = .001).
  • Probable attempt-related PTSD was strongly associated with probable general PTSD: 87.7% of those with probable attempt-related PTSD also had probable general PTSD, versus 45.0% without attempt-related PTSD (OR = 8.744, 95% CI = 4.674–16.356, p < .001).
  • Individuals with probable attempt-related PTSD reported higher current suicidal intent than those without (M = 3.68 vs. 2.86; F[1, 371] = 7.726, p = .006); the interaction with depression was significant (B = −.065, SE = .028, p = .020), with the effect significant at low depression (B = .759, SE = .313, p = .016) but not at mean or high depression.

Methods

  • Cross-sectional web-based survey conducted July–September 2018; 412 responses yielded a final sample of 386 adult suicide attempt survivors after excluding 26 who failed Conscientious Responders Scale validity checks. Inclusion required age 18+, lifetime suicide attempt per the SITBI-SF, and English fluency.
  • Measures included the SITBI-SF, LEC-5, PCL-5, a modified PCL-5-Suicide Attempts (PCL-5-SA), SBQ-R Item 4 for current suicidal intent, and PHQ-8 for depression symptoms. Probable attempt-related PTSD was derived using a DSM-5 algorithm on the PCL-5-SA, with duration >1 month considered.
  • Analyses used descriptive statistics with bootstrap confidence intervals, ANOVAs, chi-square tests, logistic regression, ANCOVA, and a PROCESS moderation model predicting suicidal intent from probable attempt-related PTSD, depression symptoms, and their interaction.

Limitations

  • The paper states that recruitment via social media and suicide-prevention/survivorship listservs limits generalizability; the sample was predominantly female-identified and White, and findings may not extend to attempt survivors at large or to other genders/racial groups.
  • The paper also states there were no pre-attempt symptom data, no instructions on how to judge “most lethal” attempt, sequential PCL-5 and PCL-5-SA administration without counterbalancing, and reliance on self-report rather than clinician-administered diagnostic tools such as the CAPS-5; PCL-5-SA psychometric properties require further study.
  • Evident from the text: the cross-sectional design cannot establish temporal or causal direction between attempt-related PTSD, depression, and suicidal intent, and the online, self-selected sample may overrepresent clinically severe or help-seeking attempt survivors.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/jclp.22833

Cites

55 of 55 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 60 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Among adult suicide attempt survivors recruited online, 27.5% screened positive for a probable diagnosis of PTSD related to their suicide attempt.

    “Overall, 27.5% (95% CI = 23.1%−31.9%) of SA survivors screened positive for a probable SA-related PTSD diagnosis.”
    • Also stated in: § Phenomenology and Rate of PTSD Related to a Suicide Attempt · plain
      “Utilizing an algorithm derived from DSM-5 diagnostic criteria for PTSD, 27.5% (95% CI = 23.1%- 31.9%; n = 106/386) of suicide attempt survivors reported a sufficient number of clinically significant symptoms with a duration of at least one month suggestive of a probable suicide attempt-related PTSD diagnosis.”
    Quote in the paperSubstantial claim
  • Findingown data

    Suicide attempt survivors with a probable suicide attempt-related PTSD diagnosis reported higher current suicidal intent than those without such a diagnosis.

    “Individuals with a probable SA-related PTSD diagnosis reported greater current suicidal intent than those without this probable diagnosis; this association was significant at low, but not high, levels of depression symptoms.”
    • Also stated in: § Suicide Attempt-Related PTSD, Depression Symptoms, and Suicidal Intent · plain
      “Compared to individuals without a probable suicide attempt-related PTSD diagnosis, individuals with a probable suicide attempt-related PTSD diagnosis reported significantly higher levels of SBQ-R suicidal intent (M[SD] = 2.86[1.48] vs. 3.68[1.44]; F[1, 371] = 7.726, p = .006, ηp2 = .02).”
    Quote in the paperSubstantial claim
  • Findingown data

    There was no significant difference in probable SA-related PTSD rate by study referral source.

    “There was no significant difference in the rate as a function of study referral source (p > .05).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Among transgender participants, 52.2% met criteria for probable SA-related PTSD.

    “Among participants identifying as transgender, 52.2% (95% CI = 27.8% - 68.4%; n = 11/23) met criteria for a probable suicide attempt-related PTSD diagnosis.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Years since one's most lethal suicide attempt were not significantly related to probable SA-related PTSD.

    “Regarding clinical characteristics, years since one’s most lethal suicide attempt was not significantly related to the presence of a probable suicide attempt-related PTSD diagnosis (p > .05).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 27
  • Classified as probably not a substantial claim. 21

  • May combine two claims.

    Findingown data

    76.9% of the sample reported a traumatic exposure consistent with DSM-5 PTSD Criterion A, and 4.1% reported a suicide attempt as their traumatic exposure without being prompted.

    “Overall, when considering open textbox responses on the LEC-5, 76.9% (n = 297) of the sample reported a traumatic exposure consistent with DSM-5 PTSD Criterion A; notably, 4.1% (n = 16) of the sample reported a suicide attempt as their traumatic exposure within this textbox (without being prompted to consider a suicide attempt as a potential traumatic event).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Probable SA-related PTSD diagnostic status did not significantly vary by gender, ethnicity, sexual orientation, educational attainment, or marital status.

    “Suicide attempt-related PTSD diagnostic status did not significantly vary as a function of gender, ethnicity, sexual orientation, educational attainment, or marital status (ps > .05).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The overall interaction model including covariates was statistically significant and explained 23.5% of the variance in SBQ-R current suicidal intent.

    “The overall interaction model, with the aforementioned covariates, was statistically significant (F[7, 366] = 16.067, p < .001) and accounted for 23.5% of the variance in SBQ-R current suicidal intent.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    98.1% of participants exceeded the clinical cutoff for SBQ-R suicide risk and 62.0% exceeded the clinical cutoff for PHQ-8 depression symptom severity.

    “Among our participants, 98.1% and 62.0% exceeded the clinical cutoffs for SBQ-R suicide risk and PHQ-8 depression symptom severity, respectively;”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The effect of probable suicide attempt-related PTSD diagnosis on SBQ-R current suicidal intent was significant at low PHQ-8 depression symptoms (B = .759, SE = .313, p = .016), but not at mean or high levels.

    “Findings revealed that the effects of a probable suicide attempt-related PTSD diagnosis on SBQ-R current suicidal intent was significant at low (B = .759, SE = .313, p = .016), but neither mean (B = .346, SE = .195, p = .077) nor high levels of PHQ-8 depression symptoms (B = −.067, SE = .202, p = .738).”
    • Also stated in: § Discussion · plain
      “It is noteworthy that the association between a probable attempt-related PTSD diagnosis and current suicidal intent was significant only at low levels of depression symptoms.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The PCL-5-SA validly identifies PTSD symptoms specifically attributable to the respondent's suicide attempt.

  • May combine two claims.

    Premisecitation

    In Bill et al. (2012), 46.7% of 30 suicide attempt survivors with prior inpatient hospitalization for major depression screened positive for suicide attempt-related PTSD, and 10% had subthreshold symptoms.

    “When considering participants’ most recent suicide attempt as the index trauma, Bill et al. (2012) found that 14 (46.7%) screened positive for suicide attempt-related PTSD and an additional 3 (10%) reported subthreshold suicide attempt-related PTSD.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Bill et al. (2012)

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    In this sample, PCL-5-SA internal consistency was excellent for the total scale and good-to-excellent for symptom clusters.

    “In this sample, the internal consistency was excellent for the total scale (α = .95) and good-to-excellent for the symptom clusters (αs = .88-.90).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Neither DSM-5 nor common PTSD assessment tools explicitly assess one's own suicide attempt as a potentially traumatic event.

    “However, neither the DSM-5 nor common PTSD-specific assessment instruments (e.g., the Life Events Checklist-5; Weathers, Blake, et al., 2013) explicitly mention/assess one’s own suicide attempt as a potentially traumatic event.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites APA, 2013

      Not checked in the free run.

    • cites Weathers, Blake, et al., 2013

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The SBQ-R has strong psychometric properties.

    “The SBQ-R has strong psychometric properties (Osman et al., 2001).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Osman et al., 2001

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    In this sample, PCL-5 internal consistency was excellent for the total scale and good-to-excellent for symptom clusters.

    “In this sample, the internal consistency was excellent for the total scale (α = .95) and good-to-excellent for the symptom clusters (αs = .85-.90).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Passing versus failing the CRS validity checks did not differ significantly by age, gender, race, ethnicity, education, or marital status, but heterosexual/straight participants were less likely to provide valid responses.

    “There were no statistically significant differences in age, gender, race, ethnicity, educational attainment, or marital status between those who passed and failed the CRS validity check questions (ps > .05); however, individuals identifying as heterosexual/straight were less likely than those identifying as other sexual orientations to provide valid responses to the CRS questions (χ2 [5] = 12.075,”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In this sample, PHQ-8 internal consistency was good.

    “In this sample, the internal consistency was good (α = .89).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    No PCL-5 PTSD symptom data were missing; missing data on remaining scales were minimal and handled by listwise deletion.

    “No data were missing for the PCL-5 PTSD symptom assessments, which were presented to participants relatively early in the survey battery; missing data were minimal for the remaining scales (<3%) and handled using listwise deletion.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The PHQ-8 has strong psychometric properties.

    “The PHQ-8 has strong psychometric properties (Kroenke & Spitzer, 2002; Kroenke et al., 2009).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Kroenke & Spitzer, 2002

      Not checked in the free run.

    • cites Kroenke et al., 2009

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Premisereasoning

    Bill et al.'s small and circumscribed sample limits generalizability, so larger research with suicide attempt survivors is needed.

    “The small sample size and circumscribed nature of Bill et al.’s (2012) study significantly hampers generalizability, necessitating additional research utilizing a larger sample of suicide attempt survivors.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bill et al. (2012)

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Worst-event open-text responses were reviewed by three advanced clinical psychology Ph.D. candidates for DSM-5 PTSD Criterion A consistency, with excellent interrater agreement and consensus resolution.

    “Open textbox responses describing “worst event” traumas were reviewed by three advanced Ph.D. candidates in clinical psychology to determine if the experience was consistent with DSM-5 PTSD Criterion A. Interrater agreement for inclusion was excellent (κ = .91) and discrepancies were resolved by consensus and consultation with a licensed clinical psychologist.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    People with a PTSD diagnosis were 9.8 times more likely to die by suicide than those without a PTSD diagnosis.

    “For instance, one population-based study found that individuals with a PTSD diagnosis were 9.8 times more likely to die by suicide as compared to those without a PTSD diagnosis (Gradus et al., 2010).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Gradus et al., 2010

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The LEC-5, an updated LEC, has good test-retest reliability and convergent validity.

    “The LEC-5 is an updated version of the LEC, which has good test-retest reliability and convergent validity (Gray, Litz, Hsu, & Lombardo, 2004).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gray, Litz, Hsu, & Lombardo, 2004

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The SITBI-SF has good interrater and test-retest reliability and construct validity.

    “The SITBI-SF has good reliability (i.e., interrater, test-retest) and construct validity (Nock et al., 2007).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Nock et al., 2007

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Comorbid major depression appears to strengthen the effect of PTSD on future suicidal behavior, partly through greater clinical impairment.

    “Indeed, the presence of comorbid major depression appears to potentiate the effects of PTSD on future suicidal behavior, due, in part, to greater clinical impairment (Panagioti et al., 2009).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Panagioti et al., 2009

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Twenty-six participants (6.3%) were excluded because they failed two Conscientious Responders Scale validity check questions.

    “Of these individuals, 6.3% (n = 26) were excluded from the final sample because they did not correctly answer two validity check questions derived from the Conscientious Responders Scale (CRS; e.g., “Choose the first option—”strongly disagree”—in answering this question.”; Marjanovic, Struthers, Cribbie, & Greenglass, 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Marjanovic, Struthers, Cribbie, & Greenglass, 2014

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    SBQ-R Item 4 was used as a single-item indicator of current suicidal intent, consistent with prior research and clinical recommendations.

    “Consistent with prior research (I. H. Stanley, Joiner, & Bryan, 2017) and clinical recommendations (Chu et al., 2015), SBQ-R Item 4 was utilized as a single-item indicator of current suicidal intent.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites I. H. Stanley, Joiner, & Bryan, 2017

      Not checked in the free run.

    • cites Chu et al., 2015

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The PCL-5 has good test-retest reliability and convergent and discriminant validity across samples.

    “The PCL-5 has demonstrated good test-retest reliability and convergent and discriminant validity across samples (Blevins, Weathers, Davis, Witte, & Domino, 2015; Bovin et al., 2016).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Blevins, Weathers, Davis, Witte, & Domino, 2015

      Not checked in the free run.

    • cites Bovin et al., 2016

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Past research suggests that 25% to 50% of those exposed to particularly severe traumatic events develop lifetime PTSD.

    “Past research suggests that 25% to 50% of those exposed to traumatic events that are particularly severe in nature (e.g., sexual violence, direct combat) develop lifetime PTSD (Yehuda et al., 2015);”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Yehuda et al., 2015

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Females appear to be more susceptible to developing PTSD symptoms following trauma exposure.

    “and also appear to be more susceptible to developing PTSD symptoms following trauma exposure (Tolin & Foa, 2006).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Tolin & Foa, 2006

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    A recent study suggests that low levels of depression might facilitate individuals' ability to act on suicidal thoughts.

    “However, findings from a recent study suggest that low levels of depression might actually facilitate individuals’ ability to act on suicidal thoughts (I. H. Stanley, Yancey, Patrick, & Joiner, 2018).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites I. H. Stanley, Yancey, Patrick, & Joiner, 2018

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The PCL-5 and PCL-5-SA were administered in sequential order without counterbalancing to control for potential practice and/or fatigue effects.

    “An additional limitation involves the administration of the PCL-5 and PCL-5-SA in sequential order without counterbalancing to control for potential practice and/or fatigue effects.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    When examining cisgender individuals, females are more likely than males to make and survive a suicide attempt.

    “when examining cisgender individuals, females are more likely than males to make and survive a suicide attempt (Nock et al., 2008; Piscopo et al., 2016),”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Nock et al., 2008

      Not checked in the free run.

    • cites Piscopo et al., 2016

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Elevated suicidal intent and predictions that one may make a suicide attempt in the future are considered particularly concerning signals of risk, including among attempt survivors.

    “Elevated suicidal intent and predictions that one may make a suicide attempt in the future are considered particularly concerning signals of risk (Chu et al., 2015), including among attempt survivors (Stefansson et al., 2012).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Chu et al., 2015

      Not checked in the free run.

    • cites Stefansson et al., 2012

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The findings support the conjecture and offer preliminary evidence that PTSD can emerge following one's own suicide attempt.

    “These findings support the aforementioned conjectures that one’s own suicide attempt might contribute to the development of PTSD (I. H. Stanley, Boffa, et al., 2019; Wulsin & Goldman, 1993).”
    • Also stated in: § Discussion · boosted
      “our results offer compelling preliminary evidence for the notion that PTSD can emerge following one’s own suicide attempt.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites I. H. Stanley, Boffa, et al., 2019

      Not checked in the free run.

    • cites Wulsin & Goldman, 1993

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Prior theoretical and empirical work suggests that depression symptoms potentiate the effects of PTSD on suicide risk.

    “At first glance, these findings are contrary to what might be expected given prior theoretical and empirical work suggesting that depression symptoms potentiate the effects of PTSD on suicide risk (Panagioti et al., 2009).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Panagioti et al., 2009

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The PCL-5-SA full scale evinced excellent internal consistency and good-to-excellent internal consistency across each of the four subscales in the present sample.

    “Promisingly, the PCL-5-SA full scale did evince excellent internal consistency and good-to-excellent internal consistency across each of the four subscales in the present sample.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The PCL-5-SA validly identifies PTSD symptoms specifically attributable to the respondent's suicide attempt.

  • Classified as probably not a substantial claim.

    Premisecitation

    Evidence-based treatments for PTSD such as prolonged exposure or cognitive processing therapy are purported to have subsequent effects on reducing suicidality.

    “To this end, evidence-based treatments for PTSD such as prolonged exposure (PE; Foa, Hembree, & Rothbaum, 2007) or cognitive processing therapy (CPT; Resick, Monson, & Chard, 2016) are purported to have subsequent effects on reducing suicidality (Cox et al., 2016; Gradus, Suvak, Wisco, Marx, & Resick, 2013).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Cox et al., 2016

      Not checked in the free run.

    • cites Gradus, Suvak, Wisco, Marx, & Resick, 2013

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Findings suggest that PTSD resulting from a suicide attempt may confer risk for future suicide attempts and thus may warrant targeted clinical assessment and intervention.

    “Findings suggest that PTSD resulting from a suicide attempt may confer risk for future suicide attempts and thus may warrant targeted clinical assessment and intervention.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The present sample was predominantly female-identified, and thus these findings may not generalize to individuals who identify as another gender.

    “Moreover, the present sample was predominantly female-identified, and thus these findings may not generalize to individuals who identify as another gender.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Individuals were recruited via social media outlets and listservs focused on suicide prevention and suicide attempt survivorship; therefore, findings may not generalize to attempt survivors at large.

    “First, individuals were recruited for this study via social media outlets and listservs focused on suicide prevention and suicide attempt survivorship. Therefore, findings may not generalize to attempt survivors at large.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The general pattern of findings is consistent with the broader scientific literature on PTSD, indicating that a signal is present.

    “However, that our general pattern of findings is consistent with the broader the scientific literature on PTSD indicates that a signal is present—that is,”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Respondents were not provided with instructions on how to determine the medical lethality of their prior suicide attempts, so there may be a discrepancy between participants' perceptions of 'most lethal' and researchers' and clinicians' categorization of medical lethality.

    “An additional limitation of the present study is that, although individuals were instructed to consider their “most lethal” suicide attempt when responding to the assessment of PTSD symptoms, respondents were not provided with instructions on how to determine the medical lethality of their prior suicide attempts. It is possible that there was a discrepancy between participants’ perceptions of “”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Beck, Beck, & Kovacs, 1975

      Not checked in the free run.

    • Rests on an assumption: Participants' self-identified most lethal suicide attempt corresponds to the medically most lethal attempt.
38 of 38

  • The paper relies on this without support.

    The web-based sample of suicide attempt survivors is representative of suicide attempt survivors broadly.

    “Participants were recruited from various sources, including social media outlets and listservs focused on suicide prevention and suicide attempt survivorship (July 2018 to September 2018).”
    “The final sample was composed of 386 suicide attempt survivors.”

  • The paper relies on this without support.

    The PCL-5-SA validly identifies PTSD symptoms specifically attributable to the respondent's suicide attempt.

    “Further work is also required to investigate the psychometric properties of the PCL-5-SA; ideally, this would include the sensitivity and specificity of identifying cases of attempt-related PTSD in conjunction with a clinical interview.”

  • The paper relies on this without support.

    Participants' self-identified most lethal suicide attempt corresponds to the medically most lethal attempt.

    “respondents were not provided with instructions on how to determine the medical lethality of their prior suicide attempts.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Transgender subgroup percentage does not match its count

    Minor

    Eleven of 23 participants is 47.8%, not 52.2%.

    Reported 52.2 · recomputed 47.826087

  • Overall algorithm-based PTSD rate changes from 27.5% to 27.2%

    Minor

    The later passage calls 27.2% the algorithm-based rate for the sample, whereas the results report 27.5% (106 of 386). The 27.2% figure was previously reported for cisgender females.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 6

  1. Hines K., 2013, Cracked, not broken: Surviving and thriving after a suicide attempt
  2. Joiner T. E., 2005, Why people die by suicide
  3. National Action Alliance for Suicide Prevention: Research Prioritization Task Force, 2014, A prioritized research agenda for suicide prevention: An action plan to save lives
  4. Piscopo K. Lipari R. N. Cooney J. &Glasheen C.(2016).Suicidal thoughts and behavior among adults: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review.
  5. Runyon B., 2004, The burn journals
  6. Weathers F. W., 1991, The PTSD Checklist Military Version (PCL‐M)

Cited by

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Related

Authors
Stanley, I. H., Hom, M. A., Boffa, J. W., Stage, D. L., & Joiner, T. E.
Affiliations
  • Florida State University (US)
  • Live Through This
Corresponding author
Stanley, Ian H.
ORCID
Venue
Journal of Clinical Psychology
Publisher
Wiley
Published
2019-07-23
Volume
75
Issue
10
Pages
1879-1895
ISSN
  • 0021-9762 (ISSN-L)
  • 1097-4679
DOI
10.1002/jclp.22833
PMC
PMC6744326
OpenAlex
W2964202185
Semantic Scholar
4eded91f91e3bf3bec6a28aa52509db45505dcf5
Cited by
39
References
55
Citations by year
2026: 4 · 2025: 3 · 2024: 10 · 2023: 6 · 2022: 2 · 2021: 10 · 2020: 4
FWCI
4.67
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Clinical Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
U.S. Department of Defense (W81XWH‐16‐2‐0003)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
Keywords
post-traumatic stress disorder, suicide attempts, suicide attempt survivors, suicidal intent, depressive symptoms, suicide risk, PTSD prevalence
MeSH terms
Adult, Female, Humans, Male, Middle Aged, Stress Disorders, Post-Traumatic, Suicide, Attempted, Survivors

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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