Differential patterns of daily trauma-related avoidance among suicide attempters and non-attempters

Suicidal thoughts and behaviors (STBs) are highly comorbid with posttraumatic stress disorder (PTSD), underscoring the need to better understand transdiagnostic factors that may contribute to both STBs and PTSD. One promising mechanism that may link PTSD and STBs is the proclivity to engage in avoidance-related behaviors. However, little research has examined how suicide attempt (SA) history may modulate the use of avoidance strategies among individuals with elevated PTSD symptoms.

Trauma-exposed participants with elevated PTSD symptoms (N = 96) were recruited to complete a battery of clinical interviews and self-report measures. A subset of participants (n = 82) completed 3 surveys/week for 2 weeks assessing their PTSD symptom severity. Multi-level models were fit to examine the differences in the use of trauma-related avoidance in response to person-centered fluctuations in concurrent and lagged traumatic intrusions among those with and without past SAs.

Relative to non-attempters, those with past SAs reported greater avoidance on days that they experienced within-person increases in traumatic intrusions. This association only held when examining concurrent intrusion-avoidance relations. Lagged increases of intrusions were related to subsequent avoidance behaviors among non-attempters but not those with past SAs.

The present study is among the first to demonstrate greater trauma-related avoidance on days with elevated traumatic intrusions among suicide attempters, relative to non-attempters. These findings have important implications for understanding STBs and suggests that the proclivity to engage in greater avoidance-related behaviors may be a transdiagnostic factor linking PTSD and STBs.