PTSD Raises the Risk of Suicidal Ideation and Suicide Risk: What’s Shame Got To Do With It?

Suicidal ideation and attempts among college students have been increasing for two decades. A 2021 paper estimated that 199,000 college students in the United States report suicidal ideation, 90,000 report a history of suicide planning, and 20,000 report having attempted suicide. And suicide is the third leading cause of death for people ages 15 to 24 in the U.S.

Post-traumatic stress disorder (PTSD) is a well-established risk factor for all the above. Increased shame, which can lead to greater isolation, has been suggested as a reason for previous study findings that more PTSD symptoms are associated with higher suicide risk. Shame has been found to be a predictor of suicidal ideation and behaviors, and a few studies have explored the associations among PTSD, shame and suicidal ideation and risk among people in the military.

But no published research until now had examined these relationships among university students, especially those experiencing PTSD symptoms stemming from trauma, who may experience feelings of inferiority, helplessness, or vulnerability at an age that is particularly challenging.

Senior author Anka A. Vujanovic, Ph.D., a licensed clinical psychologist and a professor at Texas A&M University and director of its Trauma and Stress Studies Center, and colleagues conducted a secondary analysis of data from a larger project examining emotion and coping behaviors among university students.

The new study included 1,497 students over 18 (average age 21.3 years; 78% female; 43% white, 33% Asian, 12% Black; 33% Hispanic; divided more or less equally among the four undergraduate years), who reported experiencing or witnessing at least one potentially traumatic event(natural disaster, car crash, fire or explosion, life-threatening illness or injury, assault, and so on).

They filled out multiple standard questionnaires to determine lifetime exposure to potentially traumatic events, PTSD symptom severity, suicidal ideation and behaviors, and experience and degree of shame, among others.

The researchers’ analyses evaluated PTSD symptom severity as a predictor of suicidal ideation and risk, and shame as an explanatory or mediator variable. The study findings were published in the January 2025 issue of Psychological Trauma: Theory, Research, Practice, and Policy.

Severity of PTSD symptoms was associated with level of shame, and level of shame was associated with suicidal ideation and suicide risk. When controlling for shame, symptom severity was significantly associated with both suicide measures.

As the researchers had hypothesized, PTSD symptom severity also exerted a statistically significant indirect effect on suicidal ideation and suicide risk through shame.

Other notable findings: More than 30% of the participating students met the criteria for a probable PTSD diagnosis, which is slightly higher than in other (earlier) studies and far higher than general population estimates of new cases in any given year (5%). And nearly 35% met standard criteria for suicide risk, which is higher than in a study published five years ago.

This is a cross-sectional study and as such, cannot indicate causality; the authors recommended that future studies use more rigorous methodologies, like longitudinal designs.

Reflecting on the particular vulnerabilities of college students with a history of trauma, the authors note that shame may be malleable through common evidence-based interventions such as cognitive behavioral therapy and mindfulness therapy.

The study findings “highlight the need to continue suicide prevention efforts on university campuses, particularly among students experiencing PTSD symptomatology,” the authors write. For example, “university counseling centers could implement PTSD symptom assessment into mental health services and triage to evidence-based treatment services accordingly.”