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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Cross-national analysis of the associations among mental disorders and suicidal behavior: Findings from the WHO World Mental Health Surveys
PLoS Medicine, Volume 6, No. 8, Article 1000123, Year 2009
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Description
Background: Suicide is a leading cause of death worldwide. Mental disorders are among the strongest predictors of suicide; however, little is known about which disorders are uniquely predictive of suicidal behavior, the extent to which disorders predict suicide attempts beyond their association with suicidal thoughts, and whether these associations are similar across developed and developing countries. This study was designed to test each of these questions with a focus on nonfatal suicide attempts. Methods and Findings: Data on the lifetime presence and age-of-onset of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) mental disorders and nonfatal suicidal behaviors were collected via structured face-to-face interviews with 108,664 respondents from 21 countries participating in the WHO World Mental Health Surveys. The results show that each lifetime disorder examined significantly predicts the subsequent first onset of suicide attempt (odds ratios [ORs] = 2.9-8.9). After controlling for comorbidity, these associations decreased substantially (ORs = 1.5-5.6) but remained significant in most cases. Overall, mental disorders were equally predictive in developed and developing countries, with a key difference being that the strongest predictors of suicide attempts in developed countries were mood disorders, whereas in developing countries impulse-control, substance use, and post-traumatic stress disorders were most predictive. Disaggregation of the associations between mental disorders and nonfatal suicide attempts showed that these associations are largely due to disorders predicting the onset of suicidal thoughts rather than predicting progression from thoughts to attempts. In the few instances where mental disorders predicted the transition from suicidal thoughts to attempts, the significant disorders are characterized by anxiety and poor impulse-control. The limitations of this study include the use of retrospective self-reports of lifetime occurrence and age-of-onset of mental disorders and suicidal behaviors, as well as the narrow focus on mental disorders as predictors of nonfatal suicidal behaviors, each of which must be addressed in future studies. Conclusions:This study found that a wide range of mental disorders increased the odds of experiencing suicide ideation. However, after controlling for psychiatric comorbidity, only disorders characterized by anxiety and poor impulse-control predict which people with suicide ideation act on such thoughts. These findings provide a more fine-grained understanding of the associations between mental disorders and subsequent suicidal behavior than previously available and indicate that mental disorders predict suicidal behaviors similarly in both developed and developing countries. Future research is needed to delineate the mechanisms through which people come to think about suicide and subsequently progress from ideation to attempts. © 2009 Nock et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC2717212/bin/pmed.1000123.s001.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC2717212/bin/pmed.1000123.s002.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC2717212/bin/pmed.1000123.s003.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC2717212/bin/pmed.1000123.s004.pdf
Authors & Co-Authors
Nock, Matthew K.
United States, Cambridge
Harvard University
Hwang, Irving H.
United States, Boston
Harvard Medical School
Sampson, Nancy A.
United States, Boston
Harvard Medical School
Kessler, Ronald C.
United States, Boston
Harvard Medical School
Angermeyer, Matthias Claus
Austria, Gosim
Center for Public Mental Health
Beautrais, Annette
New Zealand, Christchurch
University of Otago, Christchurch
Borges, Guilherme Luiz Guimaraes
Mexico, Mexico
Universidad Autónoma Metropolitana
Bromet, Evelyn J.
United States, Stony Brook
Renaissance School of Medicine at Stony Brook University
Bruffaerts, Ronny
Belgium, Leuven
Ku Leuven– University Hospital Leuven
de Girolamo, Giovanni
Italy, Brescia
Irccs Centro San Giovanni Di Dio Fatebenefratelli
de Graaf, Ron
Netherlands, Utrecht
Trimbos Institute, Netherlands Institute of Mental Health and Addiction
Florescu, Silvia E.
Romania, Bucharest
Scoala Nationala de Sanatate Publica si Management Sanitar, Bucharest
Gureje, Oye
Nigeria, Ibadan
University College Hospital, Ibadan
Haro, Josep Maria
Spain, Madrid
Instituto de Salud Carlos Iii
Hu, Chiyi
China, Shenzhen
Szu-shenzhen Kangning Hospital
Huang, Yueqin
China, Beijing
Peking University Sixth Hospital
Karam, Elie Georges
Lebanon, Al Koura
University of Balamand
Kawakami, Norito
Japan, Tokyo
The University of Tokyo
Kovess - Masfety, Viviane
France, Paris
Université Paris Cité
Levinson, Daphna
Israel, Jerusalem
Mental Health Services Ministry of Health
Posada-Villa, J. A.
Colombia, Bogota
Pontificia Universidad Javeriana
Sagar, Rajesh Pragna
India, New Delhi
All India Institute of Medical Sciences, new Delhi
Tomov, Toma
Bulgaria, Sofia
New Bulgarian University
Viana, Maria Carmen
Brazil, Sao Paulo
Universidade de São Paulo
Williams, David R.
United States, Boston
Harvard T.h. Chan School of Public Health
Statistics
Citations: 675
Authors: 25
Affiliations: 23
Identifiers
Doi:
10.1371/journal.pmed.1000123
ISSN:
15491277
e-ISSN:
15491676
Research Areas
Mental Health
Substance Abuse
Study Design
Cross Sectional Study
Cohort Study