Suicide amongst people with PTSD

Post Traumatic Stress Disorder (PTSD) and Complex PTSD (C-PTSD) can feel like being stuck in a nightmare, and it’s not unusual for some people to experience thoughts of suicide.

In 2024, 7,147 deaths were registered as suicide across the UK*. Studies have consistently shown that people who have experienced a traumatic event, or who have PTSD or C-PTSD, are at greater risk of suicide. Those findings are difficult to read, particularly if you are living with the condition yourself, or love someone who is. But increased risk is not the same as inevitability, and the research also shows that most of these deaths are preventable.

The connection between PTSD, C-PTSD and suicide

PTSD is more common than most people realise. The Adult Psychiatric Morbidity Survey found that 5.7% of adults in England screened positive for PTSD in the past month, which is around 2.6 million people. Among 16 to 24 year olds, the figure was 11.4%.

The same survey found that across the adult population as a whole, one in four people (25.2%) had thought about taking their own life at some point, and 7.8% had made an attempt. In the past year alone, 6.7% of adults had experienced suicidal thoughts, up from 3.8% in 2000.

For people with PTSD, the risk is considerably higher. A 2023 review pooling the findings of 60 studies found that, compared with people without the condition, people with PTSD were around three times more likely to experience suicidal thoughts, around four times more likely to attempt suicide, and around twice as likely to die by suicide. 

There is growing evidence that C-PTSD carries its own distinct risk. Research across four countries found that among adults who experienced childhood maltreatment, C-PTSD was linked to suicidality over and above PTSD alone. The difficulties that define C-PTSD, including problems with emotional regulation, a deeply negative sense of self, and difficulty in relationships, appear to contribute to suicide risk in their own right rather than simply reflecting more severe PTSD.

Knowing exactly how many people with PTSD or C-PTSD experience suicidal thoughts, attempt suicide, or die by suicide will always be impossible to establish precisely. But the evidence for a strong and consistent association is now substantial.

Research led by University College London followed more than 3.1 million people in Sweden. It found that people diagnosed with PTSD died by suicide at a rate of 53.9 per 100,000 person years, compared with 12.9 per 100,000 in the general population.

After accounting for other factors, including previous mental health diagnoses, they found women with PTSD were around 2.6 times more likely to die by suicide and men around 1.7 times more likely than people without the condition.

The same researchers estimated that around 1.6% of all suicides in the general population could be attributed to PTSD, and specifically 3.8% of suicides among women.

Crucially, the same research also points to how much of this may be avoidable, which we look at below.

What this tells us about PTSD, C-PTSD and Suicide

The most important finding in the UCL-led research is not how high the risk is. It is how much of it may be avoidable.

The researchers calculated that, if PTSD were prevented or fully resolved, and assuming the link between the two is causal, as much as 53.7% of suicides among people with PTSD might not happen. They are careful to say that causality is not proven. But the direction is clear: a substantial proportion of these deaths are linked to a condition that can be treated, and they are not fixed outcomes.

The research points to several specific things that would make a difference.

Recognising that the risk exists at all. The authors’ central recommendation is that clinical guidelines on managing PTSD, including those produced by NICE, should explicitly recognise the increased risk of suicide in people with the condition. The current NICE guideline on PTSD asks clinicians to carry out a risk assessment, and to put a safety plan in place where a significant risk of harm to self is identified. But it does not use the word suicide anywhere in its recommendations, and offers no guidance on how to assess suicide risk in PTSD specifically. Naming the risk explicitly would change what clinicians look for.

Acting quickly after diagnosis. Among people with PTSD who died by suicide, the median time between diagnosis and death was under two and a half years, with half of those deaths occurring roughly one to five years afterwards. The researchers describe this short window as a reason for rapid intervention. In the UK, it is also the period in which many people are still waiting for treatment to begin.

Safety planning and restricting access to means. The authors describe means restriction as “the suicide prevention intervention with the strongest evidence for effectiveness,” and say it should be an important consideration for people with PTSD, particularly where medication that could be dangerous in overdose is being prescribed. This is a practical, unglamorous step that is not currently routine in PTSD care.

Taking a previous suicide attempt seriously. Around 57% of the increased suicide risk associated with PTSD was accounted for by previous suicide attempts. A past attempt is one of the clearest signals that somebody needs active, sustained support, and it is one that services too often record and then move past.

Knowing who is most at risk. The researchers identified several groups at particularly raised risk: people who have made a previous suicide attempt, people with a personal or family history of mental illness, young adults, especially those aged 20 to 24, and people living in the most deprived communities. Risk is not spread evenly, and support should not be either.

The authors are honest about what is still unknown. There is limited evidence on whether trauma-focused therapies such as CBT reduce suicidality specifically, as opposed to reducing PTSD symptoms, and they call for clinical trials to establish this. That gap in the research is itself part of the problem.

Left undiagnosed, untreated or insufficiently supported, the depression, despair, isolation and guilt linked to PTSD and C-PTSD can escalate quickly, leaving people with the belief that suicide is their only escape. But PTSD and C-PTSD are treatable conditions, at any point, however long ago the trauma happened. Effective therapies for PTSD and C-PTSD exist. What is missing is speed of access, routine attention to suicide risk alongside treatment, and research into which therapies reduce that risk most.

What is PTSD UK doing to address this issue?

The research points to a small number of things that make the difference between someone with PTSD or C-PTSD getting help and not getting it. Our work is built around those points.

Helping people recognise what is happening to them

One of the starkest findings is how short the window is. Among people with PTSD who died by suicide, the median time between diagnosis and death was under two and a half years. But that clock starts at diagnosis, and for many people diagnosis comes years after the trauma, if it comes at all.

Many people live with PTSD or C-PTSD without knowing that’s what it is. They know they are not sleeping, that they are angry or numb, that they cannot be in certain places or around certain people, and they often conclude that something is fundamentally wrong with them as a person. C-PTSD in particular is still poorly understood, and people who have experienced prolonged or repeated trauma frequently do not see themselves in the usual descriptions of PTSD at all.

That is why awareness is not a soft aim for us. Recognising the condition is the first step towards being diagnosed, and being diagnosed is the first step towards treatment. Every person who reads about the symptoms and thinks ‘that is me’ is potentially years earlier into that process than they would otherwise have been.

We publish accessible, evidence-based information on the causes of PTSD and C-PTSD, the full range of symptoms, and how the conditions present differently in different people, and we work to get that information in front of people who are not looking for it yet.

Making treatment feel possible

Knowing you have PTSD or C-PTSD is not much use if you believe nothing can be done about it. Many people assume that trauma is permanent, that it is too late, or that whatever happened to them was not ‘bad enough’ to justify treatment.

PTSD and C-PTSD are treatable, at any point, however long ago the trauma happened. We provide clear information on the treatments available in the UK, including EMDR, CBT and a number of other treatments and therapies: what each one actually involves, how to ask for them, and how they can help.

Community, and the difference it makes to feel less alone

Isolation and hopelessness often come hand-in-hand with PTSD and C-PTSD. People describe that ‘nobody else could understand’, that they are a ‘burden to the people around them’, and that this is ‘simply how life will be from now on’.

Our community exists to interrupt that. Seeing that other people have felt exactly what you are feeling is not a clinical intervention, but the belief that your situation is unique and permanent can be one of the hardest things to deal with and being shown otherwise matters.

Stories of recovery

We publish the experiences of people living with PTSD and C-PTSD, in their own words, including people who have come through periods when they did not expect to survive.

We do this deliberately. Someone in the middle of PTSD or C-PTSD is often unable to imagine a version of their life that is bearable. A person who has been there and is now on the other side of it offers something that statistics and treatment information cannot: evidence that recovery is real, told by someone with no reason to pretend.

Pushing for change in how PTSD is treated

We are part of the National Suicide Prevention Alliance (NSPA), which brings together organisations working to reduce suicide across the UK.

The researchers behind the UCL study above recommended that clinical guidelines on managing PTSD, including those produced by NICE, should explicitly recognise the increased risk of suicide in people with the condition, and that further clinical trials are needed to establish which treatments reduce that risk. We are working on a number of campaigns to try to ensure this is recognised.

What to do if you’re feeling suicidal

If you’re feeling like you want to die, it’s important to tell someone.

If you are feeling suicidal now you may be feeling very alone, lost, frightened, confused. You may be feeling there is no other way out of your problem, difficulties, worries, feelings, or whatever reason you are contemplating taking your life.

It may be that at the moment you are so overcome with feelings, sadness, despair, that you are not able to think clearly about other possibilities, other solutions, other alternatives, other ways of coping.

If you cannot see for yourself a reason to carry on living, try and give others the chance to explore with you whether they can help you – give someone a chance to do that for you.

Help and support is available right now if you need it. You do not have to struggle with difficult feelings alone. There are a number of support phone lines listed at the bottom of this page for you to contact by phone, email or even text.

If you need help, or someone to talk to, please don’t wait. You can also try these tips for coping right now:

• try not to think about the future – just focus on getting through today
• stay away from drugs and alcohol
• get yourself to a safe place, like a friend’s house
• be around other people
• do something you usually enjoy, such as spending time with a pet

Let family or friends know what’s going on for you. They may be able to offer support and help keep you safe.

There’s no right or wrong way to talk about suicidal feelings – starting the conversation is what’s important.

If you have seriously harmed yourself or you feel that you may be about to harm yourself, call 999 for an ambulance or go straight to A&E. Or ask someone else to call 999 or take you to A&E.

What to do if someone you know needs support

If you’re worried someone might be experiencing suicidal thoughts – we encourage you to ask them directly.

The Samaritans note, ‘Asking someone if they’re suicidal won’t make things worse. Evidence shows it could protect them.

If someone is feeling suicidal, it might be hard to get through to them. They might be distant or distracted or feel disconnected from the world and their own emotions. They might not respond right away. But asking someone directly if they’re having suicidal thoughts can give them permission to tell you how they feel.

If someone does let you know that they are having suicidal thoughts, always take them seriously. You don’t have to be an expert, just being there to listen and showing you care can help them work through what’s going on. Let them know they’re not a burden and there’s always someone they can turn to – whether it’s a family member or friend, or a 24/7 helpline like Samaritans.

It’s OK to ask about suicidal thoughts. It could save a life.’

IF YOU, OR ANYONE YOU KNOW IS IN IMMEDIATE DANGER, PLEASE CALL 999.

For urgent psychological support, please call the Samaritans on 116 123 or text SHOUT to 85258 to reach trained volunteers at Shout. 

Alternatively, contact one of the organisations listed below:

• SANE 0300 304 7000 sane.org.uk Offers emotional support and information for anyone affected by mental health problems.
• Samaritans 116 123 (freephone) samaritans.org Samaritans are open 24/7 for anyone who needs to talk. You can visit some Samaritans branches in person. Samaritans also have a Welsh Language Line on 0808 164 0123 (7pm–11pm every day).
• Shout 85258 (text SHOUT) giveusashout.org Confidential 24/7 text service offering support if you are in crisis and need immediate help.
• Mind Support Helpline: 0300 102 1234 The team at Mind (mind.org.uk) provide information on a range of topics including: types of mental health problems, where to get help and medication and alternative treatments. They will look for details of help and support in your own area. The lines are open 9am to 6pm, Monday to Friday (except for bank holidays)
• CALM, Campaign Against Living Miserably, 0800 58 58 58, open 5pm to midnight every day, offering support to anyone who is struggling, with a webchat service at thecalmzone.net.

**It is important to note, that these deaths didn’t all happen in 2024, and we will not know how many did until all deaths are officially registered- this can sometimes take a number of years. Find out more about how suicide deaths are reported here.