Co-morbid PTSD and suicidality in individuals with schizophrenia and substance and alcohol abuse
Abstract
Background Suicide risk is high in schizophrenic patients and is further elevated in dual diagnosis patients. Suicide behaviour is a continuum from ideation, plans to attempts. Exposure to traumatic stress and co-morbid PTSD is elevated in schizophrenic patients. Suicide behaviour is also common in non-psychotic PTSD patients. This study aimed to investigate the effect of trauma and co-morbid PTSD on suicide behaviour in dual diagnosis patients and whether co-morbid PTSD would further elevate suicide risk.Method This was a cross-sectional study in which suicide behaviour was compared in those with and without co-morbid PTSD in 110 patients suffering schizophrenia and alcohol and/or substance abuse.Results 100 (91%) reported at least one traumatic event with an average of 4.3 events. 31 (28%) patients met criteria for full PTSD. Current suicidal ideation was reported by 39 (35%) and 23 (21%) reported plans and ideation, 69 (63%) reported at least one previous suicide attempt. Suicide behaviour was significantly associated with an increasing number of traumatic events. Suicidality was significantly associated and elevated with co-morbid PTSD. Analysis indicated that the effect of trauma on suicide behaviour appeared to be mediated by hopelessness.Conclusions Suicide behaviour was not associated with exposure to trauma per se but was associated with incremental exposure to traumatic experiences. Consistent with the study hypotheses, co-morbid PTSD further adds to the risk of suicide behaviour in an already vulnerable group.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
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?
Psychosis itself can function as an adverse event for individuals with psychotic disorders.
“several studies have suggested that psychosis itself can function as an AE for individuals with PDs [5–8], resulting in similarly poor outcomes.”
Cites
Baron, R. M., & Kenny, D. A. (1986) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.51.6.1173 · Cited by 91,542 · see citing works
Baron, R. M., & Kenny, D. A. (1986) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.51.6.1173 · Cited by 91,532 · see citing works
The Positive and Negative Syndrome Scale (PANSS) for schizophrenia.
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987) · Schizophrenia Bulletin · doi:10.1093/schbul/13.2.261 · Cited by 21,378 · see citing works
SPSS and SAS procedures for estimating indirect effects in simple mediation models
Preacher, K. J., & Hayes, A. F. (2004) · Behavior Research Methods, Instruments, & Computers · doi:10.3758/bf03206553 · Cited by 17,383 · see citing works
The measurement of pessimism: the hopelessness scale
Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974) · Journal of Consulting and Clinical Psychology · doi:10.1037/h0037562 · Cited by 5,494 · see citing works
Regier, D. A. (1990) · JAMA · doi:10.1001/jama.1990.03450190043026 · Cited by 3,962 · see citing works
Assessment of suicidal intention: The Scale for Suicide Ideation.
Beck, A. T., Kovacs, M., & Weissman, A. (1979) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.47.2.343 · Cited by 3,419 · see citing works
Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997) · Psychological Assessment · doi:10.1037/1040-3590.9.4.445 · Cited by 2,709 · see citing works
Regier, D. A., Farmer, M. E., Rae, D. S., et al. (1990) · PubMed · Cited by 1,913 · see citing works
Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients
(1990) · American Journal of Psychiatry · doi:10.1176/ajp.147.2.190 · Cited by 1,120 · see citing works
The Lifetime Risk of Suicide in Schizophrenia: A Reexamination
Palmer, B. A., Pankratz, V. S., & Bostwick, J. M. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.3.247 · Cited by 1,026 · see citing works
Reliability and validity of the positive and negative syndrome scale for schizophrenics
Kay, S. R., Opler, L. A., & Lindenmayer, J.-P. (1988) · Psychiatry Research · doi:10.1016/0165-1781(88)90038-8 · Cited by 1,007 · see citing works
Excess mortality of schizophrenia: A meta-analysis
Brown, S. (1997) · British Journal of Psychiatry · doi:10.1192/bjp.171.6.502 · Cited by 869 · see citing works
Trauma and posttraumatic stress disorder in severe mental illness.
Mueser, K. T., Goodman, L. B., Trumbetta, S. L., Rosenberg, S. D., Osher, F. C., Vidaver, R. M., Auciello, P., & Foy, D. W. (1998) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.66.3.493 · Cited by 790 · see citing works
Trauma and posttraumatic stress disorder in severe mental illness.
Mueser, K. T., Goodman, L. B., Trumbetta, S. L., Rosenberg, S. D., Osher, F. C., Vidaver, R., Auciello, P., & Foy, D. W. (1998) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.66.3.493 · Cited by 790 · see citing works
Schizophrenia and suicide: Systematic review of risk factors
Hawton, K. E., Sutton, L., Haw, C., Sinclair, J., & Deeks, J. J. (2005) · The British Journal of Psychiatry · doi:10.1192/bjp.187.1.9 · Cited by 777 · see citing works
Reliability and validity of a depression rating scale for schizophrenics
Addington, D., Addington, J., Maticka-Tyndale, E., & Joyce, J. (1992) · Schizophrenia Research · doi:10.1016/0920-9964(92)90003-n · Cited by 651 · see citing works
Relationships between trauma and psychosis: A review and integration
Morrison, A. P., Frame, L., & Larkin, W. (2003) · British Journal of Clinical Psychology · doi:10.1348/014466503322528892 · Cited by 535 · see citing works
Schizophrenics Kill Themselves Too: A Review of Risk Factors for Suicide
Caldwell, C. B., & Gottesman, I. I. (1990) · Schizophrenia Bulletin · doi:10.1093/schbul/16.4.571 · Cited by 511 · see citing works
Weaver, T., Madden, P., Charles, V., Stimson, G., Renton, A., Tyrer, P., Barnes, T., Bench, C., Middleton, H., Wright, N., et al. (2003) · British Journal of Psychiatry · doi:10.1192/bjp.183.4.304 · Cited by 386 · see citing works
Relationships between trauma and psychosis: an exploration of cognitive and dissociative factors
Kilcommons, A. M., & Morrison, A. P. (2005) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2005.00623.x · Cited by 341 · see citing works
Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders
Fenton, W. S., McGlashan, T. H., Victor, B. J., & Blyler, C. R. (1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.2.199 · Cited by 325 · see citing works
Psychosocial Approaches to Dual Diagnosis
Drake, R. E., & Mueser, K. T. (2000) · Schizophrenia Bulletin · doi:10.1093/oxfordjournals.schbul.a033429 · Cited by 308 · see citing works
Psychosocial Interventions for People With Both Severe Mental Illness and Substance Misuse
Hunt, G. E., Siegfried, N., Morley, K. C., Sitharthan, T., & Cleary, M. L. (2013) · Schizophrenia Bulletin · doi:10.1093/schbul/sbt160 · Cited by 282 · see citing works
Mueser, K. T., Rosenberg, S. D., Fox, L., Salyers, M. P., Ford, J. D., & Carty, P. (2001) · Psychological Assessment · doi:10.1037//1040-3590.13.1.110 · Cited by 282 · see citing works
Margolese, H., Malchy, L., Negrete, J., Tempier, R., & Gill, K. (2004) · Schizophrenia Research · doi:10.1016/s0920-9964(02)00523-6 · Cited by 277 · see citing works
Post-traumatic stress disorder and suicidal behavior: A narrative review
Panagioti, M., Gooding, P., & Tarrier, N. (2009) · Clinical Psychology Review · doi:10.1016/j.cpr.2009.05.001 · Cited by 267 · see citing works
Self-citationSpecificity of the Calgary Depression Scale for schizophrenics
Addington, D. E., ADDINGTON, J., & Maticka‐Tyndale, E. (1994) · Schizophrenia Research · doi:10.1016/0920-9964(94)90017-5 · Cited by 267 · see citing works
Can we predict suicide and non-fatal self-harm with the Beck Hopelessness Scale? A meta-analysis
McMILLAN, D., GILBODY, S., BERESFORD, E., & NEILLY, L. (2007) · Psychological Medicine · doi:10.1017/s0033291706009664 · Cited by 254 · see citing works
Depression, Hopelessness and Suicide in Chronic Schizophrenia
Drake, R. E., & Cotton, P. G. (1986) · The British Journal of Psychiatry · doi:10.1192/bjp.148.5.554 · Cited by 254 · see citing works
Psychological Vulnerability to Completed Suicide: A Review of Empirical Studies
Conner, K. R., Duberstein, P. R., Conwell, Y., Seidlitz, L., & Caine, E. D. (2001) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.31.4.367.22048 · Cited by 251 · see citing works
McGorry, P. D., Chanen, A. M., McCarthy, E. A., RIEL, R. V., McKenzie, D. P., & SINGH, B. S. (1991) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199105000-00002 · Cited by 246 · see citing works
Substance use disorders in schizophrenia: review, integration, and a proposed model
Blanchard, J. (2000) · Clinical Psychology Review · doi:10.1016/s0272-7358(99)00033-1 · Cited by 240 · see citing works
Suicide among schizophrenics: A review
Drake, R. E., Whitaker, A., Gates, C., & Cotton, P. G. (1985) · Comprehensive Psychiatry · doi:10.1016/0010-440x(85)90053-7 · Cited by 240 · see citing works
Johnson, J., Gooding, P., & Tarrier, N. (2008) · Psychology and Psychotherapy: Theory, Research and Practice · doi:10.1348/147608307x244996 · Cited by 222 · see citing works
Self-citationAddington, D. E., Addington, J., & Atkinson, M. J. (1996) · Schizophrenia Research · doi:10.1016/0920-9964(95)00070-4 · Cited by 221 · see citing works
Mueser, K. T., Rosenberg, S. D., Fox, L., et al. (2001) · Psychological Assessment · doi:10.1037/1040-3590.13.1.110 · Cited by 216 · see citing works
Suicide risk in civilian PTSD patients: Predictors of suicidal ideation, planning and attempts
Tarrier, N., & Gregg, L. (2004) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-004-0799-4 · Cited by 213 · see citing works
Self-citationKavanagh, D., Waghorn, G., Jenner, L., Chant, D., Carr, V., Evans, M., Herrman, H., Jablensky, A., & McGrath, J. (2004) · Schizophrenia Research · doi:10.1016/s0920-9964(03)00130-0 · Cited by 200 · see citing works
Crumlish, N., Whitty, P., Kamali, M., Clarke, M., Browne, S., McTigue, O., Lane, A., Kinsella, A., Larkin, C., & O’Callaghan, E. (2005) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2005.00620.x · Cited by 190 · see citing works
Suicidal behaviour and mortality in first-episode psychosis: the OPUS trial
Bertelsen, M., Jeppesen, P., Petersen, L., Thorup, A. A. E., ⊘hlenschlæger, J., le Quach, P., Christensen, T. Ø., Krarup, G., J⊘rgensen, P., & Nordentoft, M. (2007) · The British Journal of Psychiatry · doi:10.1192/bjp.191.51.s140 · Cited by 187 · see citing works
Deployment-related stress and trauma in Dutch soldiers returning from Iraq
Engelhard, I. M., van den Hout, M., Weerts, J. M. P., Arntz, A. R., Hox, J. J., & McNally, R. J. (2007) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.106.034884 · Cited by 178 · see citing works
Depression, Suicide, and Suicide Prevention in Schizophrenia
Fenton, W. S. (2000) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.2000.tb01063.x · Cited by 175 · see citing works
The subjective consequences of suffering a first episode psychosis: trauma and suicide behaviour
Tarrier, N., Khan, S., Cater, J., & Picken, A. (2007) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-006-0127-2 · Cited by 155 · see citing works
Self-citationMEYER, H., TAIMINEN, T., VUORI, T., ÄIJÄLÄ, A., & HELENIUS, H. (1999) · The Journal of Nervous & Mental Disease · doi:10.1097/00005053-199906000-00003 · Cited by 131 · see citing works
Psychosocial interventions for people with both severe mental illness and substance misuse
Cleary, M. L., Hunt, G. E., Matheson, S. L., Siegfried, N., & Walter, G. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001088.pub2 · Cited by 130 · see citing works
Suicide Attempts in Schizophrenia
Harkavy‐Friedman, J., Kimhy, D., Nelson, E. A., Venarde, D. F., Malaspina, D., & Mann, J. J. (2003) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v64n0803 · Cited by 128 · see citing works
Linking Posttraumatic Stress Disorder and Psychosis
Seedat, S., Stein, M. B., Oosthuizen, P. P., Emsley, R. A., & Stein, D. J. (2003) · The Journal of Nervous and Mental Disease · doi:10.1097/01.nmd.0000092177.97317.26 · Cited by 126 · see citing works
Bolton, C. A., Gooding, P. A., Kapur, N., Barrowclough, C., & Tarrier, N. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2006.12.001 · Cited by 107 · see citing works
Self-citationWe Can Talk: Individual Psychotherapy for Schizophrenia
Fenton, W. S. (1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.11.1493 · Cited by 101 · see citing works
Pinninti, N. R., Steer, R. A., Rissmiller, D. J., Nelson, S., & Beck, A. T. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(02)00002-5 · Cited by 98 · see citing works
Risk of non-fatal suicide ideation and behaviour in recent onset schizophrenia
Tarrier, N., Barrowclough, C., Andrews, B., & Gregg, L. (2004) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-004-0828-3 · Cited by 88 · see citing works
Self-citationSuicide behaviour over 18 months in recent onset schizophrenic patients: The effects of CBT
Tarrier, N., Haddock, G., Lewis, S., Drake, R., & Gregg, L. (2006) · Schizophrenia Research · doi:10.1016/j.schres.2005.12.846 · Cited by 88 · see citing works
Self-citationCauses of Posttraumatic Stress Disorder in Psychotic Patients
Frame, L., & Morrison, A. P. (2001) · Archives of General Psychiatry · doi:10.1001/archpsyc.58.3.305 · Cited by 78 · see citing works
Involuntary admission and posttraumatic stress disorder symptoms in schizophrenia patients
Priebe, S., Bröker, M., & Gunkel, S. (1998) · Comprehensive Psychiatry · doi:10.1016/s0010-440x(98)90064-5 · Cited by 75 · see citing works
Suicidal Ideation in Inpatients with Acute Schizophrenia
Kontaxakis, V. P., Havaki-Kontaxaki, B. J., Margariti, M. M., Stamouli, S. S., Kollias, C. T., & Christodoulou, G. N. (2004) · The Canadian Journal of Psychiatry · doi:10.1177/070674370404900709 · Cited by 66 · see citing works
Mueser, K. T., Rosenberg, S. D., Jankowski, M. K., Hamblen, J. L., & Descamps, M. J. (2004) · American Journal of Psychiatric Rehabilitation · doi:10.1080/15487760490476183 · Cited by 64 · see citing works
Preliminary Reliability and Validity of the Clinician-Administered PTSD Scale for Schizophrenia.
Gearon, J. S., Bellack, A. S., & Tenhula, W. N. (2004) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.72.1.121 · Cited by 54 · see citing works
Barrowclough, C., Haddock, G., Beardmore, R., Conrod, P., Craig, T., Davies, L., Dunn, G., Lewis, S., Moring, J., Tarrier, N., et al. (2009) · Addictive Behaviors · doi:10.1016/j.addbeh.2009.03.007 · Cited by 51 · see citing works
Self-citationTarrier, N., Gooding, P. A., Gregg, L., Johnson, J., & Drake, R. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.03.007 · Cited by 45 · see citing works
Self-citationSuicide attempts of high medical seriousness in schizophrenic patients
Nieto, E., Vieta, E., Gastó, C., Vallejo, J., & Cirera, E. (1992) · Comprehensive Psychiatry · doi:10.1016/0010-440x(92)90060-4 · Cited by 41 · see citing works
Suicide schemas in non-affective psychosis: An empirical investigation
Pratt, D., Gooding, P. A., Johnson, J., Taylor, P. J., & Tarrier, N. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.08.005 · Cited by 38 · see citing works
Self-citationTarrier, N. (2005) · Behaviour Change · doi:10.1375/bech.2005.22.3.125 · Cited by 20 · see citing works
Self-citationSpecificity of the calgary depression scale
Addington, D. E., Addington, J., & Maticka‐Tyndale, E. (1993) · Schizophrenia Research · doi:10.1016/0920-9964(93)90083-u · Cited by 11 · see citing works
Tarrier, N., Barrowclough, C., Andrews, B., & Gregg, L. (2004) · Research Explorer (The University of Manchester) · Cited by 9 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Complex PTSD, affect dysregulation, and borderline personality disorder
Ford, J. D., & Courtois, C. A. (2014) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/2051-6673-1-9 · Cited by 182 · see citing works
A systematic review on comorbid post-traumatic stress disorder in schizophrenia.
Seow, L. S. E., Ong, C., Mahesh, M. V., Sagayadevan, V., Shafie, S., Chong, S. A., & Subramaniam, M. (2016) · Schizophrenia Research · doi:10.1016/j.schres.2016.05.004 · Cited by 134 · see citing works
Patterson, V. C., Tibbo, P. G., Stewart, S. H., Town, J., Crocker, C. E., Ursuliak, Z., Lee, S., Morrison, J., Abidi, S., Dempster, K., et al. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06050-1 · Cited by 1 · see citing works
“In addition, several studies have suggested that psychosis itself can function as an AE for individuals with PDs [5–8], resulting in similarly poor outcomes.”
Background
- Authors
- Tarrier, N., & Picken, A.
- Affiliations
- University of Manchester (GB)
- Corresponding author
- Tarrier, Nicholas
- Venue
- Social Psychiatry and Psychiatric Epidemiology
- Published
- 2010-08-15
- Volume
- 46
- Issue
- 11
- Pages
- 1079-1086
- ISSN
- 0933-7954 (ISSN-L)
- 1433-9285
- OpenAlex
- W1973867472
- Cited by
- 33
- References
- 65
- Citations by year
- 2025: 1 · 2024: 3 · 2022: 4 · 2020: 2 · 2018: 2 · 2017: 4 · 2016: 4 · 2015: 2 · 2014: 2 · 2013: 4 · 2012: 1
- FWCI
- 3.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- schizophrenia, post-traumatic stress disorder, suicidality, dual diagnosis, substance abuse, alcohol abuse, suicide risk, trauma exposure, suicidal ideation, suicide attempts, hopelessness, comorbidities
- MeSH terms
- Adult, Cross-Sectional Studies, England, Female, Humans, Male, Middle Aged, Schizophrenia, Stress Disorders, Post-Traumatic, Comorbidity, Substance-Related Disorders, Suicidal Ideation
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.
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 ›
Are you an author, or do you see a problem with this page? Request a review
