Will treating PTSD increase the risk of suicide?

Clients with PTSD are often distressed. Concern about their wellbeing is often part of the process for a clinician. Sometimes part of this concern is because of the client’s suicidal ideation. At times this concern includes if treatment will reduce or increase suicidal ideation.

Brown et al. (2019) examined prolonged exposure and found that treatment with this therapy was associated with significant reductions in suicidal ideation over time that were superior to a minimal contact control. They also examined Present Centred Therapy (PCT) which is considered a non-trauma-focused treatment (PCT has a focus on psychoeducation about the associated features and symptoms of PTSD. It also aims to increase the client’s awareness of how these symptoms may be related to day-to-day problems.) This was also found to be superior to a minimal contact control.

Gradus et al. (2013) found that suicidal ideation decreased sharply during treatment with cognitive processing therapy (CPT) or prolonged exposure (PE). They also found that more subtle decreases in suicidal ideation occurred during the follow-up period. Importantly these decreases were associated with decreases in PTSD symptoms over the course of treatment. Similarly, these decreases were not accounted for by depression diagnoses at the start of the study or changes in hopelessness during treatment. Gradus et al. (2013) also reported that CPT exhibited a larger influence on suicidal ideation than PE, although the scale of the difference was small.


Another factor to consider in the decision-making process when a client reports suicidal ideation is comorbidity. Krysinska and Lester (2010) reported that the evidence indicated that there was an association between factors, such as concurrent depression and pre-trauma psychiatric condition, and suicidality in those with PTSD.


The research indicates that suicidal ideation in those with PTSD is decreased by PTSD treatment. However, co-morbidity and pre-existing psychiatric conditions need to be considered.

Brown, L. A., McLean, C. P., Zang, Y., Zandberg, L., Mintz, J., Yarvis, J. S., . . . Foa, E. B. (2019). Does prolonged exposure increase suicide risk? Results from an active duty
military sample. Behaviour Research and Therapy, 118, 87-93. PTSDpubs ID: 52064

Gradus JL, Suvak MK, Wisco BE, Marx BP, Resick PA. Treatment of posttraumatic stress disorder reduces suicidal ideation. Depress Anxiety. 2013 Oct;30(10):1046-53. doi: 10.1002/da.22117. Epub 2013 May 1. PubMed PMID: 23636925.

Krysinska K, Lester D. Post-traumatic stress disorder and suicide risk: a systematic review. Arch Suicide Res. 2010;14(1):1-23. doi: 10.1080/13811110903478997. Review. PubMed PMID: 20112140.