Posttraumatic stress disorder, suicidal ideation, and suicidal self-directed violence among U.S. military personnel and veterans: A systematic review of the literature from 2010 to 2018
Open accessAbstract
Rates of suicide and posttraumatic stress disorder remain high among United States military personnel and veterans. Building upon prior work, we conducted a systematic review of research published from 2010 to 2018 regarding: (1) the prevalence of suicidal ideation, suicide attempt, and suicide among United States military personnel and veterans diagnosed with posttraumatic stress disorder; (2) whether posttraumatic stress disorder was associated with suicidal ideation, suicide attempt, and suicide among United States military personnel and veterans. 2,106 titles and abstracts were screened, with 48 articles included. Overall risk of bias was generally high for studies on suicidal ideation or suicide attempt and low for studies on suicide. Across studies, rates of suicidal ideation, suicide attempt, and suicide widely varied based on study methodology and assessment approaches. Findings regarding the association between posttraumatic stress disorder diagnosis with suicidal ideation and suicide were generally mixed, and some studies reported that posttraumatic stress disorder was associated with lower risk for suicide. In contrast, most studies reported significant associations between posttraumatic stress disorder and suicide attempt. These findings suggest complex associations between posttraumatic stress disorder and suicidal ideation, suicide attempt, and suicide, which are likely influenced by other factors (e.g., psychiatric comorbidity). In addition, most samples were comprised of veterans, rather than military personnel. Further research is warranted to elucidate associations between posttraumatic stress disorder and suicidal ideation, suicide attempt, and suicide, including identification of moderators and mediators of this relationship. Addressing this among United States military personnel, by gender, and in relation to different trauma types is also necessary.
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Among U.S. military personnel or veterans with PTSD, the lifetime prevalence of suicidal ideation is 35%, suicide attempts is 20%, and suicide death is 0.16%.
“a recent review indicated that among U.S. military personnel or veterans with PTSD, the lifetime prevalence of suicidal ideation, suicide attempts, and suicide death is 35%, 20%, and 0.16%, respectively (Holliday et al., 2020).”
From An Open-Phase Pilot Trial of an Integration of Prolonged Exposure Therapy and the Coping Long-Term With Active Suicide Program (2026) · cites this paper as Holliday et al., 2020
The Results > Synthesis of Literature (page unavailable) reviews suicidal ideation, attempts, and suicide among U.S. military personnel or veterans with PTSD. It reports varying rates rather than the cited 35%, 20%, and 0.16% lifetime prevalence figures: lifetime ideation ranged from 17.39% to 71.89%, while the reported percentages who died by suicide ranged from <0.01% to 0.30%. The review therefore supports the population and outcomes, but not those three specific lifetime estimates. (LLM, conf=0.83)
Experimental — accuracy not yet measuredPosttraumatic stress disorder (PTSD) increases the risk of suicidal ideation, suicide attempts, and suicide death.
“Posttraumatic stress disorder (PTSD) increases the risk of suicidal ideation, suicide attempts, and suicide death (Holliday et al., 2020).”
From An Open-Phase Pilot Trial of an Integration of Prolonged Exposure Therapy and the Coping Long-Term With Active Suicide Program (2026) · cites this paper as Holliday et al., 2020
The Results and Discussion (KQ2; page numbers not supplied) report a largely consistent association between PTSD and suicide attempts among U.S. military personnel and veterans. Findings for suicidal ideation and suicide death were mixed, including studies finding no increased risk or a lower risk of suicide. The review therefore does not support the unqualified, causal claim that PTSD increases the risk of all three outcomes. (LLM, conf=0.88)
Experimental — accuracy not yet measuredWithin military populations, PTSD is a critical factor to account for when attempting to ameliorate elevated suicide risk.
“Within military populations, PTSD is a critical factor to account for when attempting to ameliorate this elevated risk (Holliday et al., 2020).”
From An Open-Phase Pilot Trial of an Integration of Prolonged Exposure Therapy and the Coping Long-Term With Active Suicide Program (2026) · cites this paper as Holliday et al., 2020
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Self-citationLife Meaning Is Associated With Suicidal Ideation Among Depressed Veterans
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“…13 Although the association between PTSD and suicide risk is complex and sometimes related to other factors, such as psychiatric comorbidity and demographic, social and psychological characteristics, 14 15 the need to reduce the risk associated with suicidality in this population remains critical.”
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Self-citationBeyond the observed: Postpartum posttraumatic stress symptoms and mother-child bonding in Ghana
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Honor Endorsement Strengthens Military Personnel's Help‐Seeking Stigma Toward Mental Health
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- Authors
- Holliday, R., Borges, L. M., Stearns-Yoder, K. A., Hoffberg, A. S., Brenner, L. A., & Monteith, L. L.
- Affiliations
- University of Colorado Anschutz (US)
- Corresponding author
- Holliday, Ryan
- Venue
- Frontiers in Psychology
- Publisher
- Frontiers Media SA
- Published
- 2020-08-26
- Volume
- 11
- Pages
- 1998-1998
- ISSN
- 1664-1078 (ISSN-L)
- PMC
- PMC7479813
- OpenAlex
- W3080920519
- Cited by
- 92
- References
- 102
- Citations by year
- 2026: 16 · 2025: 19 · 2024: 19 · 2023: 14 · 2022: 13 · 2021: 11
- FWCI
- 0.74
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- U.S. Department of Veterans Affairs
- NIH Clinical Center
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Education › Education and Military Integration
- Keywords
- post-traumatic stress disorder, suicidal ideation, suicide attempts, suicide, military personnel, veterans, suicide risk, psychiatric comorbidity, trauma type, gender differences
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