Current and former soldiers who seek treatment for post-traumatic stress disorder (PTSD) should be screened closely for major depression since the disorder is the single strongest driver of suicidal thinking, say authors of a new Canadian study.
Researchers evaluated 250 active duty Canadian Forces, RCMP members and veterans. The study comes at a time when record numbers of suicides are being reported among American troops returning from Afghanistan and Iraq, and the number of suicides reported among Canadian forces last year reached its highest point since 1995.
In veterans suffering from post-traumatic stress disorder, about half also have symptoms of major depressive disorder during their lifetime, said the researchers.
But “the task of predicting which people may be at an increased risk of completing suicide is a complex and challenging care issue,” they said.
The study included 193 Canadian Forces vets, 55 active troops and two RCMP members referred to the Parkwood Hospital Operational Stress Injury Clinic in London, Ontario.
Soldiers and vets were screened for PTSD, major depression, anxiety disorders and alcohol abuse. The depression questionnaire also included questions about suicidal thinking.
Study participants served an average of 15 years and had been deployed an average of three times. About one-fourth had been deployed to Afghanistan at least once. Ninety-two per cent were men.
Most met the criteria for “probable” PTSD, and almost three-fourths screened positive for probable major depression.
Overall, about one-fourth — 23 percent — said that they had experienced thoughts of self-harm, or that they would be better off dead, for several days over the prior two weeks.
Another 17 percent said they had those thoughts more than half of the days in the past two weeks; six percent reported feeling this way almost every day for the previous two weeks.
As found in other studies, the researchers showed that PTSD is linked to suicidal thoughts. But “what became the biggest predictor was, specifically, depression severity,” said Dr. Don Richardson, a consultant psychiatrist at the Operational Stress Injury Clinic and an adjunct professor in the department of psychiatry at Western University in London.
“It really stresses the importance that when you’re assessing someone for PTSD it’s also critical that you assess specifically for major depression,” Richardson said. “From our limited study, it was depression severity that was the most significant predictor of having suicidal ideation.”
The concern is that soldiers seeking treatment for military-related trauma might not receive aggressive therapy for depression. Instead, the focus might be more focused on PTSD and exposure therapy.
“There’s potentially a lot of people out there who are suffering who might not be aware that there are effective treatments, and that there are clinics available across Canada that specialize in military trauma,” said Richardson.