Post-Traumatic Stress Disorder and Risk of All-Cause and Cause-Specific Mortality: A Nationwide Population and Sibling-Controlled Cohort Study in Taiwan

Authors

• Chih-Wei Hsu
• Yang-Chieh Brian Chen
• Liang-Jen Wang
• Mu-Hong Chen
• Yao-Hsu Yang
• Chih-Sung Liang
• Edward Chia-Cheng Lai

Language

English

Publication Date

3-3-2026

Journal

Epidemiology and Psychiatric Sciences

DOI

10.1017/S2045796026100481

PMID

41772820

PMCID

PMC12964077

PubMedCentral® Posted Date

3-3-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Aims: Post-traumatic stress disorder (PTSD) may shorten life expectancy, but evidence for Asian populations and cause-specific mortality remains limited. The aim of this study is to investigate the association between PTSD and mortality risk in an Asian population.

Methods: We used Taiwan's National Health Insurance Research Database (2000-2022) to assemble a cohort of 28,777 individuals with incident PTSD and 115,108 age- and sex-matched unexposed individuals, plus a sibling cohort of 13,305 affected patients and 22,030 unaffected siblings. Cox models estimated adjusted hazard ratios (AHRs) for all-cause, unnatural-cause (suicide and accidents) and natural-cause mortality, with progressive adjustment for sociodemographic factors, comorbidity and familial confounding. Subgroup analyses addressed five psychiatric comorbidities, sex and age (youth, adulthood and older adults).

Results: Over a mean follow-up of 8 years, PTSD was associated with excess all-cause mortality (AHR = 1.32, 95% CI 1.24-1.41) driven by markedly increased unnatural deaths (AHR = 5.93, 5.13-6.85), especially suicide (AHR = 10.36, 8.41-12.76) and accidental deaths (AHR = 2.18, 1.67-2.86). Natural-cause mortality showed no consistent increase (AHR = 0.91, 0.85-0.98). In sibling analyses, excess risks persisted for all-cause (AHR = 2.48, 2.04-3.01), unnatural deaths (AHR = 4.76, 3.58-6.34) and suicide mortality (AHR = 7.90, 5.21-11.97), but not for accidents or natural causes. The risk patterns were similar across different psychiatric comorbidity strata and genders; suicide and unnatural-cause excess remained evident in all age groups.

Conclusions: PTSD was associated with elevated premature death risk in Taiwan, primarily through suicide and unnatural causes. Integrating targeted suicide-prevention into PTSD care pathways may be essential to reducing this avoidable mortality burden.

Keywords

Humans, Taiwan, Stress Disorders, Post-Traumatic, Female, Middle Aged, Adult, Male, Cause of Death, Suicide, Siblings, Aged, Cohort Studies, Accidents, Comorbidity, Young Adult, Risk Factors, Adolescent, Proportional Hazards Models, accidents, death, mortality, PTSD, suicide

Published Open-Access

yes

Recommended Citation

Hsu, Chih-Wei; Chen, Yang-Chieh Brian; Wang, Liang-Jen; et al., "Post-Traumatic Stress Disorder and Risk of All-Cause and Cause-Specific Mortality: A Nationwide Population and Sibling-Controlled Cohort Study in Taiwan" (2026). Children’s Nutrition Research Center Staff Publications. 416.
https://digitalcommons.library.tmc.edu/staff_pub/416