You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Axis I and axis II disorders as predictors of prospective suicide attempts: findings from the collaborative longitudinal personality disorders study.
Abstract 1:
This study examined diagnostic predictors of prospect ively observed  suicide attempts in a personality disorder ( PD ) sample . During 2 years of follow-up , 58 participants ( 9 % ) reported at least 1 definitive suicide attempt . Predictors that were examined include 4 PD diagnoses and selected Axis I diagnoses ( baseline and course ) . Multivariate logistic regression analyses indicated that baseline borderline personality disorder ( BPD ) and drug use disorders significantly predicted prospect i ve suicide attempts . Controlling for baseline BPD diagnosis , proportional hazards analyses showed that worsening in the course of major depressive disorder ( MDD ) and of substance use disorders in the month preceding the attempt were also significant predictors . Therefore , among individuals diagnosed with PDs . exacerbation of Axis I conditions , particularly MDD and substance use , heightens risk for a suicide attempt


Title 2:
Prevalence of Depression–PTSD Comorbidity: Implications for Clinical Practice Guidelines and Primary Care-based Interventions
Abstract 2:
BACKGROUND Compared to those with depression alone , depressed patients with posttraumatic stress disorder ( PTSD ) experience more severe psychiatric symptomatology and factors that complicate treatment . OBJECTIVE To estimate PTSD prevalence among depressed military veteran primary care patients and compare demographic/illness characteristics of PTSD screen-positive depressed patients ( MDD-PTSD+ ) to those with depression alone ( MDD ) . DESIGN Cross-sectional comparison of MDD patients versus MDD-PTSD+ patients . PARTICIPANTS Six hundred seventy-seven r and omly sample d depressed patients with at least 1 primary care visit in the previous 12 months . Participants composed the baseline sample of a group r and omized trial of  collaborative care for depression in 10 VA primary care practice s in 5 states . MEASUREMENTS The Patient Health Question naire-9 assessed MDD . Probable PTSD was defined as a Primary Care PTSD Screen ≥ 3 . Regression-based techniques compared MDD and MDD-PTSD+ patients on demographic/illness characteristics . RESULTS Thirty-six percent of depressed patients screened positive for PTSD . Adjusting for sociodemographic differences and physical illness comorbidity , MDD-PTSD+ patients reported more severe depression ( P < .001 ) , lower social support ( P < .001 ) , more frequent outpatient health care visits ( P < .001 ) , and were more likely to report suicidal ideation ( P < .001 ) than MDD patients . No differences were observed in alcohol consumption , self-reported general health , and physical illness comorbidity . CONCLUSIONS PTSD is more common among depressed primary care patients than previously thought . Comorbid PTSD among depressed patients is associated with increased illness burden , poorer prognosis , and delayed response to depression treatment . Providers should consider recommending psychotherapeutic interventions for depressed patients with PTSD


Title 3:
Health care utilization and its costs for depressed veterans with and without comorbid PTSD symptoms.
Abstract 3:
OBJECTIVE This study examined health care utilization and costs of care among Veterans Affairs ( VA ) patients with depression and with or without symptoms of comorbid posttraumatic stress disorder ( PTSD ) . METHODS Cross-sectional comparisons of health care utilization and costs were conducted with VA administrative data for a sample of veterans from a r and omized trial of collaborative care depression treatment in ten VA primary care clinics across five states . Patients with depression or dysthymia were included in the study , and those who were acutely suicidal or had probable bipolar disorder were excluded . The sample of 606 patients was mainly male , white , and aged 55 or older .  Health care utilization , costs , and medication data from VA administrative data bases were analyzed over 12 months . RESULTS Patients with depression and PTSD ( screen score > or =3 ) were more emotionally distressed , had more frequent mental health specialty visits ( 6.91 versus 1.68 , p<.001 ) , more total outpatient visits ( 26.16 versus 19.94 , p<.001 ) , and correspondingly higher outpatient mental health care costs over the previous 12 months compared with depressed patients without PTSD . Antidepressants were prescribed to a higher proportion of depressed patients with PTSD ( 61 % versus 40 % ) . CONCLUSIONS Patients with PTSD and depression had greater utilization of specialty mental health treatments  and  antidepressant medications  and higher mental health care costs in the previous 12 months than depressed patients without PTSD . As military personnel return from Iraq , both VA and non-VA health care providers need to plan for an increase in outpatient mental health services and costs , particularly among depressed veterans who also have PTSD


Title 4:
Suicides and serious suicide attempts: two populations or one?
Abstract 4:
BACKGROUND Few studies have examined the extent to which population s of  suicides and attempted suicides  are similar , or different . This paper compares suicides and serious suicide attempts in terms of known risk factors for suicidal behaviour . METHODS Using case-control methodology , risk factors for suicidal behaviour were examined in 202 individuals who died by suicide , 275 individuals who made medically serious suicide attempts and 984 r and omly selected control subjects . Based on data from significant others , measures used spanned  sociodemographic factors , childhood experiences , psychiatric morbidity and psychiatric history , exposure to recent stressful life events and social interaction .  RESULTS Multiple logistic regression identified the following risk factors that were common to suicide and serious suicide attempts : current mood disorder ; previous suicide attempts ; prior outpatient psychiatric treatment ; admission to psychiatric hospital within the previous year ; low income ; a lack of formal educational qualifications ; exposure to recent stressful interpersonal , legal and work-related life events . Suicides and suicide attempts were distinguished in the following ways : suicides were more likely to be male ( OR = 1.9 , 95 % CI 1.1 , 3.2 ) ; older ( OR = 1.03 , 95 % CI 1.02 , 1.04 ) ; and to have a current diagnosis of non-affective psychosis ( OR = 8.5 , 95 % CI 2.0 , 35.9 ) . Suicide attempts were more likely than suicides to have a current diagnosis of anxiety disorder ( OR = 3.5 , 95 % CI 1.6 , 7.8 ) and to be socially isolated ( OR = 2.0 , 95 % CI 1.2 , 3.5 ) . These findings were confirmed by discriminant function analysis , which identified two functions that described the three subject groups : the first function discriminated the two suicide groups from control subjects on a dimension corresponding to risk factors for suicide ; the second function discriminated suicide from suicide attempt subjects on a series of factors including gender , non-affective psychosis and anxiety disorder . CONCLUSIONS Suicides and medically serious suicide attempts are two overlapping population s that share common psychiatric diagnostic and history features , but are distinguished by gender and patterning of psychiatric disorder


Title 5:
PTSD, depression, and their comorbidity in relation to suicidality: cross-sectional and prospective analyses of a national probability sample of women.
Abstract 5:
BACKGROUND A growing body of literature implicates major depressive disorder ( MDD ) and posttraumatic stress disorder ( PTSD ) as risk factors for suicidal ideation ( SI ) and suicide attempts ( SA ) , though research has not adequately examined their differential contributions to increasing suicide risk prospect ively or cross-sectionally . METHODS The contribution of these disorders and their comorbidity to SI and SA was examined using a national household probability sample of women ( N=3,085 ) and covarying for trauma history , substance abuse , and demographic variables .  RESULTS Cross-sectional analyses indicated that lifetime comorbidity of MDD and PTSD were associated with much higher prevalence of SI than either diagnosis alone ; prevalence of SI was elevated and comparable for PTSD and MDD only . Comorbid diagnosis and PTSD only groups displayed greater prevalence of SA than those with MDD only . Lastly , a 2-year prospect i ve analysis indicated that PTSD only at baseline was predictive of greater subsequent SI risk than MDD only , though comorbid diagnosis did not differ from either PTSD only or MDD only . CONCLUSIONS PTSD appears to be a particularly strong predictor of SI and SA . Overall , only 16 % of women with lifetime SA did not have a history of MDD or PTSD , highlighting the importance of assessing these variables when assessing suicide risk


Title 6:
Posttraumatic stress disorder and suicide attempts in a community sample of urban american young adults.
Abstract 6:
CONTEXT Previous research has shown that exposure to traumatic events , especially sexual trauma during childhood , is associated with an increased risk of attempted suicide . However , no information is available as to whether the increased risk of attempted suicide is related primarily to posttraumatic stress disorder ( PTSD ) following traumatic experiences or applies also to persons who experienced trauma but did not develop PTSD . OBJECTIVE We examine the association between exposure to traumatic events with and without result ing PTSD and the risk of a subsequent suicide attempt in a community sample of urban young adults . DESIGN A cohort study followed young adults who had participated in a r and omized trial of all first- grade students entering 19 public schools . SETTING Baltimore , Maryl and , an urban setting . PARTICIPANTS A total of 1698 young adults ( mean age , 21 ; 47 % male ; 71 % African American ) who represented 75 % of the original cohort of 2311 persons . MAIN OUTCOME MEASURE Relative risk of a subsequent suicide attempt associated with PTSD and with exposure to assaultive and non-assaultive traumas ( no PTSD ) , as estimated using discrete time survival analysis . RESULTS Posttraumatic stress disorder was associated with increased risk of a subsequent suicide attempt . The PTSD-suicide attempt association was robust , even after adjustment for a prior major depressive episode , alcohol abuse or dependence , and drug abuse or dependence ( adjusted relative risk , 2.7 ; 95 % confidence interval , 1.3 - 5.5 ; P < .01 ) . In contrast , exposure to traumatic events without PTSD was not associated with an increased risk of attempted suicide . CONCLUSIONS Posttraumatic stress disorder is an independent predictor of attempted suicide . Exposure to traumatic events without PTSD is not associated with a later suicide attempt


Title 7:
Suicide Risk and Coping Styles in Posttraumatic Stress Disorder Patients
Abstract 7:
Background : Suicide and suicidal behavior have been found to be increased among posttraumatic stress disorder ( PTSD ) patients . The present study examined suicide risk and Plutchik ’s coping styles in PTSD patients . Method : 47 PTSD patients were compared with 42 patients with mixed non-PTSD anxiety disorders and 50 healthy control subjects , matched for age and gender , on a measure of suicide risk . Results : The PTSD patients scored significantly higher than the two control groups on the suicide risk measure . Furthermore , in the PTSD group , suicide risk was significantly negatively correlated with the coping mechanisms of mapping , minimization and replacement and positively correlated with the coping style of suppression . Furthermore , the coping styles significantly explained the variance of the suicide risk measure for all three groups . Conclusions : The cognitive map of PTSD patients highly resembles other population s with high suicide risk . Clinicians treating victims of traumatic events should focus on problem-solving therapies in order to help these patients deal less rigidly with everyday stresses and by this decrease the suicide risk
RESULTS A highly significant positive association between a PTSD diagnosis and suicidality was found .
The PTSD-suicidality association persisted across studies using different measures of suicidality , current and lifetime PTSD , psychiatric and nonpsychiatric sample s , and PTSD population s exposed to different types of traumas .
Comorbid major depression significantly compounded the risk for suicide in PTSD population s. CONCLUSION The current meta- analysis provides strong evidence that a PTSD diagnosis is associated with increased suicidality .
The crucial role of comorbid major depression in the etiology of suicidality in PTSD is also supported