Acute Suicidal Ideation and Behavior (ASIB) in Major Depressive Disorder (MDD) and Post-Traumatic Stress Disorder (PTSD) 

Suicide in the U.S. is a Growing Public Health Issue

Suicide can be viewed as a process that begins with suicidal ideation, followed by planning and then by a suicidal act, and suicidal ideation can be prompted by depression or PTSD

Suicide Graphic Update

1. Suicide Rising Across the US. National Center for Injury Prevention and Control. Available at: Accessed February 1, 2019.
2. Major Depression. National Institute of Mental Health. Available at: Accessed January 28, 2020.

Suicide rates have increased in nearly every state over the past two decades, and half of the states have seen suicide rates go up more than 30 percent

Suicide Rate Graphic

Source: Suicide Rising Across the US. National Center for Injury Prevention and Control.
Available at: Accessed February 1, 2019.
Greenfieldboyce, N. CDC: U.S. Suicide Rates Have Climbed Dramatically NPR.
Available at:
Accessed February 1, 2019.

Suicidality in PTSD

  • In DSM-5 suicidality is not diagnostic criterion for PTSD, however, in clinical practice working with severely traumatized patient this problem is quite common
  • Severe psychological trauma (complex trauma) often impacts all aspects of the self-structure – one’s image of the body; the internalized images of others; and one’s values and ideals – and leads to a sense that self coherence and the self’s goals are invaded, assaulted and systematically broken down
  • Due to the timeless and unintegrated nature of the traumatic memories, trauma victims remain embedded in the trauma as a contemporary experience, instead of being able to accept it is secondary and belongs to the past
  • The meaning of the traumatic past evolves over time, and often includes feelings or irretrievable loss, anger, betrayal, and hopelessness
  • Clinicians treating severe traumatized individuals should be aware that suicidality may constitute one of the most important clinical symptoms cluster to evaluate

Suicidality in MDD

  • Research has shown that more than 90% of people who kill themselves have depression or another diagnosable mental or substance abuse disorder
  • Depression is the cause of over two-thirds of the reported suicides in the U.S. each year
  • The intent of this measure is for a clinician to assess suicide risk at initial intake or at the visit in which depression was diagnosed
  • As the guidelines state, it is important to assess for additional factors which may increase or decrease suicide risk, such as presence of additional symptoms (eg, psychosis, severe anxiety, hopelessness, severe chronic pain); presence of substance abuse, history and seriousness of previous attempts, particularly, recent suicidal behavior, current stressors and potential protective factors (eg, positive reasons for living, strong social support), family history of suicide or mental illness or recent exposure to suicide, impulsivity and potential for risk to others, including history of violence or violent or homicidal ideas, plans, or intentions, and putting one's affairs in order (eg, giving away possessions, writing a will)
  • Suicide risk should be monitored especially for the 90 days following the initial visit and throughout MDD treatment

1. Suicide statistics. HCUPnet, Healthcare Cost and Utilization Project. Agency for Healthcare Research and Quality, Rockville, MD; 2013.
2. Kessler RC, Berglund P, Demler O et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psych. 2005; 62:593-602
3: Kessler RC, Chiu WT, Demler O et al. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the national comorbidity survey replication (NCS-R). Arch Gen Psych. 2005; 62:617-627
4: Sareen J, Cox BJ, Stein MB et al. Physical and mental comorbidity, disability, and sucidial behavior associated with posstraum. Psychosom Med. 2007;69:242-248