Revisión sistemática de la relación entre sintomatología postraumática y conductas suicidas


  • Esther González Gómez Universidad Complutense de Madrid
  • María Crespo López UCM


Palabras clave:

Trastorno de Estrés Postraumático, ideación suicidio, intentos de suicidio, revisión sistemática

Agencias Financiadoras:

Universidad Complutense de Madrid


Systematic review of the relationship between post-traumatic symptomatology and suicidal behavior

Abstract: Evidence has consistently demonstrated the relationship between post-traumatic stress disorder (PTSD) and suicide. However, there is little research related to the differential relationships between the PTSD symptom clusters (avoidance, re-experiencing, hyperarousal and negative alterations in cognitions and mood) and risk and suicidal behavior. The present systematic review studies the relationship between these post-traumatic symptom clusters and suicidal behavior (suicidal ideation and suicide attempts). The review includes 20 articles from the databases PsycINFO, PsycARTICLES and Web of Science. Results indicate that hyperarousal significantly predicts suicidal ideation in 53.33% and suicide attempts in 42.85% of the studies reviewed. Reduction of hyperarousal symptoms should be considered a priority objective in the development of therapeutic interventions to reduce suicide risk in people with post-traumatic conditions or diagnosed with PTSD.

Key words: PTSD; hyperarousal symptoms; suicidal ideation; suicide attempt; systematic review.

Resumen: Existe evidencia contrastada de la relación entre el trastorno de estrés postraumático (TEPT) y el suicidio. No obstante, existen pocas investigaciones sobre las relaciones diferenciales entre los grupos de síntomas de TEPT (evitación, re-experimentación, hiperactivación y alteraciones negativas cognitivas y del estado de ánimo [ANCE]) y la conducta suicida. La presente revisión sistemática estudia la relación entre estos grupos de síntomas postraumáticos y la conducta suicida (ideación e intentos suicidas). La revisión incluye 20 artículos procedentes de las bases de datos PsycINFO, PsycARTICLES y Web of Science. Los resultados apuntan que la hiperactivación predice de forma significativa la ideación suicida en el 53.33% de los estudios revisados y los intentos de suicidio en el 42.85% de los mismos. La reducción de los síntomas de hiperactivación debe considerarse un objetivo prioritario en la elaboración de intervenciones terapéuticas para reducir el riesgo suicida en personas con cuadros postraumáticos o diagnóstico de TEPT.

Palabras clave: TEPT; hiperactivación; ideación suicida; intentos de suicidio; revisión sistemática.


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Biografía del autor/a

María Crespo López, UCM




American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Health Disorders (3thEdition). Washington, DC: Author.

American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Health Disorders (3thEdition - Revised). Washington, DC: Author.

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Health Disorders (4th Edition). Washington, DC: Author.

American Psychiatric Association (2000). Diagnostic and statistical Manual of Mental Health Disorders (4th Edition - Revised). Washington, DC: Author.

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Health Disorders (5th Edition). Washington, DC: Author.

Asmundson, G. J., Stapleton, J. A., & Taylor, S. (2004). Are avoidance and numbing distinct PTSD symptom clusters? Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 17(6), 467-475.

Armour, C., Tsai, J., Durham, T. A., Charak, R., Biehn, T. L., Elhai, J. D., & Pietrzak, R. H. (2015). Dimensional structure of DSM-5 posttraumatic stress symptoms: Support for a hybrid Anhedonia and Externalizing Behaviors model. Journal of psychiatric research, 61, 106-113.

*Barr, N., Kintzle, S., Sullivan, K., & Castro, C. (2018). Suicidality and nonsuicidal high-risk behavior in military veterans: How does PTSD symptom presentation relate to behavioral risk? Traumatology, 24(1), 55–61.

*Barr, N. U., Sullivan, K., Kintzle, S., & Castro, C. A. (2016). PTSD symptoms, suicidality and non-suicidal risk to life behavior in a mixed sample of pre-and post-9/11 veterans. Social work in mental health, 14(5), 465-473.

Beck, A. T., & Steer, R. A. (1991). Manual for the Beck scale for suicide ideation. San Antonio, TX: Psychological Corporation.

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory-II. San Antonio, 78(2), 490-498.

*Bell, J. B., & Nye, E. C. (2007). Specific symptoms predict suicidal ideation in Vietnam combat veterans with chronic post-traumatic stress disorder. Military medicine, 172(11), 1144-1147.

*Ben-Ya'acov, Y., & Amir, M. (2004). Posttraumatic symptoms and suicide risk. Personality and Individual Differences, 36(6), 1257-1264.

Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75-90.

*Boffa, J. W., Stanley, I. H., Hom, M. A., Norr, A. M., Joiner, T. E., & Schmidt, N. B. (2017). PTSD symptoms and suicidal thoughts and behaviors among firefighters. Journal of psychiatric research, 84, 277-283.

Briere, J. (1995). Trauma Symptom Inventory professional manual. Odessa, FL: Psychological Assessment Resources.

Briere, J. (2001). Detailed Assessment of Posttraumatic Stress (DAPS). Odessa, FL: Psychological Assessment Resources.

*Briere, J., Godbout, N., & Dias, C. (2015). Cumulative trauma, hyperarousal, and suicidality in the general population: A path analysis. Journal of Trauma & Dissociation, 16(2), 153-169.

*Brown, K. L. (2013). The connection between post-traumatic stress disorder and suicide behavior: what links post-traumatic stress disorder to suicide? (Disertación, Universityof Toledo). Recuperado de

*Brown, L. A., Contractor, A., & Benhamou, K. (2018). Posttraumatic stress disorder clusters and suicidal ideation. Psychiatry research, 270, 238-245.

Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Archives of internal medicine, 158(16), 1789-1795.

Chu, C., Buchman-Schmitt, J. M., Michaels, M. S., Ribeiro, J. D., & Joiner, T. (2013). Discussing disgust: The role of disgust with life in suicide. International Journal of Cognitive Therapy, 6(3), 235-247.

Davidson, J. R., Book, S. W., Colket, J. T., Tupler, L. A., Roth, S., David, D., & Davison, R. M. (1997). Assessment of a new self-rating scale for post-traumatic stress disorder. Psychological medicine, 27(1), 153-160.

*Davis, M. T., Witte, T. K., Weathers, F. W., & Blevins, C. A. (2014). The role of posttraumatic stress disorder symptom clusters in the prediction of passive suicidal ideation. Psychological Trauma: Theory, Research, Practice, and Policy, 6(Suppl 1), S82–S91.

Derogatis, L. R. (1977). The SCL-90 manual F: scoring, administration and procedures of the SCL-90. Baltimore, MD: John Hopkins University, School of Medicine, Clinical Psychometrics Unit.

Derogatis, L. R., & Spencer, P. M. (1993). Brief symptom inventory: BSI (Vol. 18). Upper Saddle River, NJ: Pearson.

Eurostat (European Statistical Office of the European Commission). (20 de septiembre, 2019). Death due to suicide, by gender. Standardised death rate by 100000 inhabitants. Recuperado de

Elhai, J. D., Biehn, T. L., Armour, C., Klopper, J. J., Frueh, B. C., & Palmieri, P. A. (2011). Evidence for a unique PTSD construct represented by PTSD's D1–D3 symptoms. Journal of Anxiety Disorders, 25(3), 340-345.

Endicott, J., Nee, J., Harrison, W., & Blumenthal, R. (1993). Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure. Psychopharmacology bulletin, 29,321–326.

Feeny, N. C., Zoellner, L. A., Fitzgibbons, L. A., & Foa, E. B. (2000). Exploring the roles of emotional numbing, depression, and dissociation in PTSD. Journal of traumatic stress, 13(3), 489-498.

First, M.B., Spitzer, R.L., Williams, J.B.W., & Gibbon, M. (1997). Structured Clinical Interview for DSM-IV-Clinician Version (SCID-CV). Washington: American Psychiatric Press.

First, M., Spitzer, R., Gibbon, M., & Williams, J. (2002). Structured Clinical Interview for DSM–IV–TRAxis I Disorders, Research Version, Patient Edition. (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute.

Foa, E. B. (1995). The posttraumatic diagnostic scale (PDS) manual. Minneapolis, MN: National Computer Systems, 1-5.

Foa, E. B., McLean, C. P., Zang, Y., Zhong, J., Powers, M. B., Kauffman, B. Y., & Knowles, K. (2016). Psychometric properties of the Posttraumatic Diagnostic Scale for DSM–5 (PDS–5). Psychological Assessment, 28(10), 1166.

Goodman, L. A., Corcoran, C., Turner, K., Yuan, N., & Green, B. L. (1998). Assessing traumatic event exposure: General issues and preliminary findings for the Stressful Life Events Screening Questionnaire. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 11(3), 521-542.

Grant, B. F., Hasin, D. S., Blanco, C., Stinson, F. S., Chou, S. P., Goldstein, R. B., & Huang, B. (2005). The epidemiology of social anxiety disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of clinical psychiatry.

*Guerra, V. S., & Calhoun, P. S. (2011). Examining the relation between posttraumatic stress disorder and suicidal ideation in an OEF/OIF veteran sample. Journal of anxiety disorders, 25(1), 12-18.

Horowitz, M. (1986). Stress response syndromes. Northvale, NJ: Jason Aronson.

Iannuzzo, R. W., Jaeger, J., Goldberg, J. F., Kafantaris, V., & Sublette, M. E. (2006). Development and reliability of the HAM-D/MADRS interview: an integrated depression symptom rating scale. Psychiatryresearch, 145(1), 21-37.

Instituto Nacional de Estadística (INE). (19 de diciembre, 2018). Defunciones según la Causa de Muerte – Año 2017. España: Instituto Nacional de Estadística. Notas de prensa. Recuperado de

Joiner, T.E. (2005). Why people die by suicide. Cambridge MA: Harvard University Press.

Joiner, T. E., & Stanley, I. H. (2016). Can the phenomenology of a suicidal crisis be usefully understood as a suite of antipredator defensive reactions?.Psychiatry, 79(2), 107-119.

Kashdan, T. B., Elhai, J. D., & Frueh, B. C. (2006). Anhedonia and emotional numbing in combat veterans with PTSD. Behaviour research and therapy, 44(3), 457-467.

Keane, TM, Fairbank, JA, Caddell, JM, Zimering, RT, Taylor, KL y Mora, CA (1989). Evaluación clínica de una medida para evaluar la exposición al combate. Evaluación psicológica: una revista de consultoría y psicología clínica, 1 (1), 53–55.

King, L. A., King, D. W., Vogt, D. S., Knight, J., & Samper, R. E. (2006). Deployment Risk and Resilience Inventory: A collection of measures for studying deployment-related experiences of military personnel and veterans. Military Psychology, 18(2), 89-120.

Krysinska, K., & Lester, D. (2010). Post-traumatic stress disorder and suicide risk: A systematic review. Archives of Suicide Research, 14,1–23.

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ‐9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606-613.

Kroenke, K., Spitzer, R. L., Williams, J. B., & Löwe, B. (2009). An ultra-brief screening scale for anxiety and depression: the PHQ–4. Psychosomatics, 50(6), 613-621.

*Law, K. C., Allan, N. P., Kolnogorova, K., & Stecker, T. (2019). An examination of PTSD symptoms and their effects on suicidal ideation and behavior in non-treatment seeking veterans. Psychiatry research, 274, 12-19.

*Legarreta, M., Graham, J., North, L., Bueler, C. E., McGlade, E., & Yurgelun-Todd, D. (2015). DSM–5 posttraumatic stress disorder symptoms associated with suicide behaviors in veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 7(3), 277–285.

Leiner, A. S., Compton, M. T., Houry, D., & Kaslow, N. J. (2008). Intimate partner violence, psychological distress, and suicidality: A path model using data from African American women seeking care in an urban emergency department. Journal of Family Violence, 23(6), 473-481.

*Lemaire, C. M., & Graham, D. P. (2011). Factors associated with suicidal ideation in OEF/OIF veterans. Journal of affective disorders, 130(1-2), 231-238.

Linehan, M. M., Comtois, K. A., Brown, M. Z., Heard, H. L., & Wagner, A. (2006). Suicide Attempt Self-Injury Interview (SASII): development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury. Psychological assessment, 18(3), 303.

McFall, M., Fontana, A., Raskind, M., & Rosenheck, R. (1999). Analysis of violent behavior in Vietnam combat veteran psychiatric inpatients with posttraumatic stress disorder. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 12(3), 501-517.

Metalsky, G. I., & Joiner, T. E. (1997). The hopelessness depression symptom questionnaire. Cognitive Therapy and Research, 21(3), 359-384.

Nock, M. K., Deming, C. A., Fullerton, C. S., Gilman, S. E., Goldenberg, M., Kessler, R. C., ... & Stanley, B. (2013). Suicide among soldiers: a review of psychosocial risk and protective factors. Psychiatry: Interpersonal & Biological Processes, 76(2), 97-125.

Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-Injurious Thoughts and Behaviors Interview: Development, reliability, and validity in an adolescent sample. Psychological Assessment, 19(3), 309–317.

Organización Mundial de la Salud. (2014). Prevención del suicidio: Un imperativo global. Recuperado de

Organización Mundial de la Salud. (2 de septiembre, 2019). Suicidio. Recuperado de

Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples. Assessment, 8(4), 443-454.

*Panagioti, M., Angelakis, I., Tarrier, N., & Gooding, P. (2017). A prospective investigation of the impact of distinct posttraumatic (PTSD) symptom clusters on suicidal ideation. Cognitive therapy and research, 41(4), 645-653.

Panagioti, M., Gooding, P., & Tarrier, N. (2009). Post-traumatic stress disorder and suicidal behavior: A narrative review. Clinical psychology review, 29(6), 471-482.

Panagioti, M., Gooding, P. A., & Tarrier, N. (2012). A meta-analysis of the association between posttraumatic stress disorder and suicidality: the role of comorbid depression. Comprehensive psychiatry, 53(7), 915-930.

Panagioti, M., Gooding, P. A., Triantafyllou, K., & Tarrier, N. (2015). Suicidality and posttraumatic stress disorder (PTSD) in adolescents: a systematic review and meta-analysis. Social psychiatry and psychiatric epidemiology, 50(4), 525-537.

*Pietrzak, R. H., Tsai, J., Armour, C., Mota, N., Harpaz-Rotem, I., & Southwick, S. M. (2015). Functional significance of a novel 7-factor model of DSM-5 PTSD symptoms: Results from the National Health and Resilience in Veterans Study. Journal of Affective Disorders, 174, 522-526.

Plutchik, R., Van Praag, H. M., Conte, H. R., & Picard, S. (1989). Correlates of suicide and violence risk: the suicide risk measure. Comprehensive Psychiatry, 30(4), 296-302.

Pollock, V., Cho, D. W., Reker, D., &Volavka, J. (1979). Profile of Mood States: the factors and their physiological correlates. Journal of Nervous and Mental Disease, 167 (10), 612-614.

Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., & Mann, J. J. (2011). The Columbia–Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. American journal of psychiatry, 168(12), 1266-1277.

QualityMetric (2014). SF-8 Health Survey. QualityMetric: Lincoln, RI.

Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied psychological measurement, 1(3), 385-401.

Reynolds, W. M. (1991). Adult Suicide Ideation Questionnaire: Professional manual. Odessa, FL: Psychological Assessment Resources.

Ruan, W. J., Goldstein, R. B., Chou, S. P., Smith, S. M., Saha, T. D., Pickering, R. P., & Grant, B. F. (2008). The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): reliability of new psychiatric diagnostic modules and risk factors in a general population sample. Drug and alcohol dependence, 92(1-3), 27-36.

Rudd, M. D., Berman, A. L., Joiner Jr, T. E., Nock, M. K., Silverman, M. M., Mandrusiak, M., ... & Witte, T. (2006). Warning signs for suicide: Theory, research, and clinical applications. Suicide and Life-Threatening Behavior, 36(3), 255-262.

Rudd, M. D., Schmitz, B., McClenen, R., Joiner, T., Elkins, G., & Claassen, C. (2010). The Suicide Cognitions Scale: A suicide-specific measure of hopelessness. Journal of abnormal psychology.

Saunders, J. B., Aasland, O. G., Babor, T. F., De la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption‐II. Addiction, 88(6), 791-804.

*Selaman, Z. M., Chartrand, H. K., Bolton, J. M., & Sareen, J. (2014). Which symptoms of post-traumatic stress disorder are associated with suicide attempts?. Journal of anxiety disorders, 28(2), 246-251.

Selzer, M. L. (1971). The Michigan Alcoholism Screening Test: The quest for a new diagnostic instrument. American journal of psychiatry, 127(12), 1653-1658.

Skinner, H. A. (1982). The drug abuse screening test. Addictive behaviors, 7(4), 363-371.

*Stanley, I. H., Rogers, M. L., Hanson, J. E., Gutierrez, P. M., & Joiner, T. E. (2019). PTSD symptom clusters and suicide attempts among high-risk military service members: A three-month prospective investigation. Journal of Consulting and Clinical Psychology, 87(1), 67–78.

*Steyn, R., Vawda, N., Wyatt, G. E., Williams, J. K., & Madu, S. N. (2013). Posttraumatic stress disorder diagnostic criteria and suicidal ideation in a South African Police sample. African journal of psychiatry, 16(1), 19-22.

*Surís, A., Link‐Malcolm, J., & North, C. S. (2011). Predictors of suicidal ideation in veterans with PTSD related to military sexual trauma. Journal of Traumatic Stress, 24(5), 605-608.

Tarrier, N., & Gregg, L. (2004). Suicide risk in civilian PTSD patients. Social psychiatry and psychiatric epidemiology, 39(8), 655-661.

Taylor, S., & Cox, B. J. (1998). An expanded anxiety sensitivity index: evidence for a hierarchic structure in a clinical sample. Journal of anxiety disorders, 12(5), 463-483.

Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner Jr, T. E. (2010). The interpersonal theory of suicide. Psychological review, 117(2), 575.

*Watkins, L. E., Sippel, L. M., Pietrzak, R. H., Hoff, R., & Harpaz-Rotem, I. (2017). Co-occurring aggression and suicide attempt among veterans entering residential treatment for PTSD: The role of PTSD symptom clusters and alcohol misuse. Journal of psychiatric research, 87, 8-14.

Weathers, F. W., Huska, J., & Keane, T. (1991). The PTSD Checklist Military Version (PCL-M). Boston, MA: National Center for PTSD.

Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. In annual convention of the international society for traumatic stress studies, San Antonio, TX (Vol. 462).

Weathers, F. W., Litz, B. T., Huska, J. A., & Keane, T. M. (1994). The PTSD Checklist-Civilian Version (PCL-C) for DSM-IV. Boston: National Center for PTSD. Behavioral Science Division. VA Boston Healthcare System.

Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM-5 (PCL-5) Scale. Recuperado de National Center for PTSD

Weiss, D.S., & Marmar, C.R. (1997). The Impact of Event Scale-Revised. In J.P. Wilson & T.M. Keane (Eds.), Assessing psychological trauma and PTSD (p. 399-411). New York, NY: Guilford Press.

Wilcox, H. C., Storr, C. L., & Breslau, N. (2009). Posttraumatic stress disorder and suicide attempts in a community sample of urban American young adults. Archives of General Psychiatry, 66, 305–311.




Cómo citar

González Gómez, E., & Crespo López, M. (2022). Revisión sistemática de la relación entre sintomatología postraumática y conductas suicidas. Revista De Psicopatología Y Psicología Clínica, 27(1), 73–90.



Revisiones Sistemáticas