Journal of Traumatic Stress

, Volume 11, Issue 1, pp 103–112 | Cite as

Suicidal Behavior After Severe Trauma. Part 1: PTSD Diagnoses, Psychiatric Comorbidity, and Assessments of Suicidal Behavior

  • Marcello Ferrada-Noli
  • Marie Asberg
  • Kari Ormstad
  • Tom Lundin
  • Elisabet Sundbom


The study comprises 149 refugees from various countries, reporting exposure to severe traumata, who were referred for psychiatric diagnosis and assessment of suicide risk. The stressors reported comprised both personal experience of and/or forced witnessing of combat atrocities (including explosions or missile impacts in urban areas), imprisonment (including isolation), torture and inflicted pain, sexual violence, witnessing others' suicide, and of summary and/or mock executions. Posttraumatic stress disorder (PTSD) was diagnosed in 79% of all cases, other psychiatric illness in 16% and no mental pathology in 5%. The prevalence of suicidal behavior was significantly greater among refugees with principal PTSD diagnoses than among the remainder. PTSD patients with depression comorbidity reported higher frequency of suicidal thoughts; PTSD nondepressive patients manifested increased frequency of suicide attempts.

posttraumatic stress PTSD suicidal behavior refugees 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Alley, J. C. (1982). Life-threatening indicators among the Indochinese refugees. Suicide and Life-Threatening Behavior, 12, 46–51.Google Scholar
  2. Allody, F. A. (1991). Assessment and treatment of torture victims: A critical review. Journal of Nervous and Mental Disease, 179, 4–11.Google Scholar
  3. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC.: Author.Google Scholar
  4. Asberg, M., Montgomery, S. A., Perris, C., Schalling, D., & Sedvall, G. A. (1978). A Comprehensive Psychopathological Rating Scale (CPRS). Acta Psychiatrica Scandinavica suppl 271.Google Scholar
  5. Beiser, M., & Fleming, J. (1986). Measuring psychiatric disorder among Southeast Asian refugees. Psychological Medicine, 16, 627–639.Google Scholar
  6. Beskow, J. (1983). The problem of suicide. National Board of Health and Welfare. Stockholm: Utbildningsproduktion AB.Google Scholar
  7. Boor, M. (1981). Relationship of 1977 Sate suicide rates to population increases and immigration. Psychological Reports, 49, 856–858.Google Scholar
  8. Dahl, S. (1989). Acute response to rape—a PTSD variant. Acta Psychiatrica Scandinavica, suppl 355, 56–62.Google Scholar
  9. Farberow, N. L., Kang, H. K., & Bullman, & T. A. (1990). Combat experience and post service psychosocial status as predictors of suicide in Vietnam veterans. Journal of Nervous and Mental Disease, 178, 32–37.Google Scholar
  10. Ferrada-Noli, M. (1990, September). The study of risk factors in psychological autopsies. Paper presented at the Third European Symposium on Suicidal Behavior and Risk Factors. Bologna, Italy.Google Scholar
  11. Ferrada-Noli, M. (1993). Research on PTSD and suicide. In S. Jakobsson, Apitzsh, & C. Malmström (Eds.). After Torture. CTD yearbook (pp. 30–31. Stockholm: Liber.Google Scholar
  12. Ferrada-Noli M. (1996). Social-psychological vs. socio-economic hypothesis on the epidemiology of suicide. An empirical study. Psychological Reports, 79, 707–710.Google Scholar
  13. Ferrada-Noli, M. (1996, June) Alexithymia as a marker for suicidal behavior in posttraumatic stress disorder. Paper presented at the Sixth European Symposium on Suicide and Suicidal Behavior. Lund, Sweden, Abstracts 16:4.Google Scholar
  14. Ferrada-Noli M. (1997). A cross-cultural breakdown of Swedish suicide. Acta Psychiatrica Scandinavica, 96(2), 108–117.Google Scholar
  15. Ferrada-Noli, M., & Åsberg, M. (1996, June) A social-psychiatric hypothesis on suicidal behavior and migration. Sixth European Symposium on Suicide and Suicidal Behavior, Lund, Sweden. Abstracts P:7.Google Scholar
  16. Ferrada-Noli, M., Åsberg, M., & Ormstad, K. (1996). Pathoanatomic findings and blood alcohol analysis at autopsy (BAC) in forensic diagnoses of undetermined suicide. A cross-cultural study. Forensic Science International, 78, 157–163.Google Scholar
  17. Ferrada-Noli M., Åsberg M., Ormstad, K., & Nordström P. (1995). Definite and undetermined forensic diagnoses of suicide among immigrants in Sweden. Acta Psychiatrica Scandinavica, 91, 130–135.Google Scholar
  18. Ferrada-Noli, M., Ormstad, K. M., & Åsberg, M. (1996). Psychiatric care and transculturall factors in suicide incidence. Nordic Journal of Psychiatry, 50, 21–25.Google Scholar
  19. Ferrada-Noli, M., & Sundbom, E. (1995, May). Cultural bias in suicidal behavior among PTSD diagnoses. Paper presented at the Fourth European Conference on Traumatic Stress, Paris, France. Book of Abstracts, 51.Google Scholar
  20. Ferrada-Noli, M., & Sundbom, E. (1996). Cultural bias in suicidal behavior among refugees with posttraumatic stress disorder. Nordic Journal of Psychiatry 50, 185–191.Google Scholar
  21. Gunderson, J.G., Sabo, A. N. (1993), The phenomenological and conceptual interface between borderline personality disorder and PTSD. American Journal of Psychiatry, 150, 19–27.Google Scholar
  22. Hendin, H., & Haas, A. P. (1991). Suicide and guilt as manifestations of PTSD in Vietnam combat veterans. American Journal of Psychiatry, 148, 586–591.Google Scholar
  23. Hiley-Young, B., Blake, D. D., Abueg, F. R., Rozynko, V. & Gusman, F. D. (1995). Warzone violence in Vietnam: an examination of premilitary, military, and postmilitary factors in PTSD in-patients. Journal of Traumatic Stress, 8, 125–141.Google Scholar
  24. Hyer, L., McCranie, E. W., Woods, M. G. & Boudewyns, P. A. (1990). Suicidal behavior among chronic Vietnam theatre veterans with PTSD. Journal of Clinical Psychology, 46, 713–21.Google Scholar
  25. Kliewer, E. & Ward, R. (1988). Convergence of immigrant suicide rates. American Journal of Epidemiology, 127, 640–653.Google Scholar
  26. Kramer, T. L., Lindy, J. D., Green, B. L., Grace M., & Leonard A. (1994). The comorbidity of post-traumatic stress disorder and suicidality in Vietnam veterans. Suicide and Life-Threatening Behavior, 24, 58–67.Google Scholar
  27. Kilpatrick, D. G., Best, C. L., & Veronen, L. J. (1985). Mental health correlates of criminal victimization. Journal of Consulting and Clinical Psychology, 53, 866–873.Google Scholar
  28. Loughrey, G. C., Curran, P. S, & Bell, P. (1992). Post traumatic stress disorder and civil violence in Northern Ireland. In J.P. Wilson & B. Raphael (Eds.) International handbook of traumatic stress syndromes (pp. 377–383). N.Y: Plenum Press.Google Scholar
  29. Lundin, T. (1984). Morbidity following sudden and unexpected bereavement, British Journal of Psychiatry, 144, 84–88.Google Scholar
  30. Miller, T. W., Martin, W., & Spiro K. (1989). Traumatic stress disorder: Diagnostic and clinical issues in former prisoners of war. Comprehensive Psychiatry, 30, 139–148.Google Scholar
  31. Robins, L. N., Helzer, J. E., Croughan, J., & Ratcliff, K. S. (1981). National Institute of Mental Health Diagnostic Interview Schedule. Archives of General Psychiatry, 38, 381–389.Google Scholar
  32. Rudd, M. D., Dahm, P. F., & Rajab, H. (1993). Diagnostic comorbidity in persons with suicidal ideation and behavior. American Journal of Psychiatry, 150, 928–934.Google Scholar
  33. Solursh, L. P. (1989). Combat addiction: Overview and implications in symptom maintenance and treatment planning. Journal of Traumatic Stress, 2, 451–662.Google Scholar
  34. Somasundaram, D. (1993). Psychiatric morbidity due to war in Northern Sri Lanka. In J. P. Wilson & B. Raphael (Eds.), International handbook of traumatic stress syndromes (pp. 333–348. NY: Plenum Press.Google Scholar
  35. Svanborg, P., Åsberg, M. (1994). A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatrica Scandinavica, 89, 21–28.Google Scholar
  36. van der Veer, G. (1992). Counselling and therapy with refugees: Psychological problems of victims of war, torture and repression. New York: Wiley.Google Scholar
  37. Watson, C. G., Juba, M. P., Manifold, V., Kucala, T., & Anderson, P. E. D. (1991). The PTSD Interview: Rationale, description, reliability, and concurrent validity of a DSM-III-based technique. Journal of Clinical Psychology, 47, 179–188.Google Scholar
  38. Withlock, F. A. (1971). Migration and suicide. Medical Journal of Australia; 2, 840–8.Google Scholar

Copyright information

© International Society for Traumatic Stress Studies 1998

Authors and Affiliations

  • Marcello Ferrada-Noli
    • 1
    • 2
    • 3
    • 4
  • Marie Asberg
    • 3
  • Kari Ormstad
    • 5
  • Tom Lundin
    • 3
  • Elisabet Sundbom
    • 6
  1. 1.Department of Social MedicineHarvard Medical SchoolUSA
  2. 2.Department of PsychologyUniversity of TromsøUSA
  3. 3.Department of Clinical NeuroscienceThe KarolinskaUSA Institute
  4. 4.Department of Social MedicineHarvard Medical SchoolBoston
  5. 5.Department of Forensic MedicineThe Karolinska InstituteSweden
  6. 6.Department of Applied PsychologyUniversity of UmeåSweden

Personalised recommendations