Explaining the Link Between PTSD and Suicide: A Meta-Analysis to Introduce the CEASE Framework

Posttraumatic stress disorder is a well-known risk-factor for suicidal ideation and attempts, but there have been few attempts to systematically evaluate correlates of this association. Using purported mechanisms of the development of suicidal thoughts and behaviors across nine theories as a guide, a series of meta-analyses (K = 191 studies, N = 79,106) were conducted. Posttraumatic stress disorder had a moderate association with suicidal thoughts and behaviors. Defeat and entrapment had large associations with both posttraumatic stress disorder and suicidal thoughts and behaviors. Hopelessness, shame, guilt, anger, and negative cognitions about other people each had moderate associations with both posttraumatic stress disorder and suicidal thoughts and behaviors. Smaller but significant associations were observed for distress tolerance, aggression/hostility, social connection, negative cognitions about the self, self-harm, and acquired capability for suicide. Significant heterogeneity was detected in the meta-analyses and explored quantitatively to examine reasons for heterogeneity. These findings are consolidated into a new framework, the CEASE Framework, reflecting changes in Cognitions, Emotions, Attention/executive functioning/memory, Sensations and perceptions, and Extreme behaviors that may underlie the association between posttraumatic stress disorder and suicide risk.