Although depression is the mental disorder that most people associate with suicidal behavior, a new study reveals that a wide range of mental disorders increase the odds of thinking about suicide and making suicide attempts. Whereas depression is indeed one of the strongest predictors of suicidal thoughts across many different countries, it is disorders characterized by anxiety and poor impulse-control that best predict which people act on such thoughts--especially in developing countries, says a multi-country study published in this week's open access journal PLoS Medicine.
Using data from over 100,000 individuals in 21 countries participating in the WHO World Mental Health Surveys, Matthew Nock (Harvard University, Cambridge, Massachusetts, USA) and colleagues investigated which mental health disorders increase the odds of experiencing suicidal thoughts and actual suicide attempts, and how these relationships differ across developed and developing countries. The researchers collected and analyzed data on the lifetime presence and age-of-onset of mental disorders and of nonfatal suicidal behaviors using structured interviews.
While mental disorders are among the strongest known predictors of suicide, the multi-country study was initiated because people often have more than one mental disorder at a time and 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, say the authors.
The authors found that mental disorders are present in approximately half of people who seriously consider killing themselves and two-thirds of those who make a suicide attempt. Overall, mental disorders were equally predictive of suicidal thoughts and attempts 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
"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 are predictive of suicidal behaviors in both developed and developing countries," say the authors, but "future research is needed to further delineate the mechanisms through which people come to think about suicide and subsequently progress from suicidal thoughts to attempts."
Funding: These activities were supported by the United States National Institute of Mental Health (R01MH077883; R01MH070884), the John D. and Catherine T.MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01DA016558), the Fogarty International Center (FIRCA R01-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline, and Bristol-Myers Squibb. A complete list of WMH publications can be found at http://www.
Competing Interests: With the exception of Ronald C Kessler no author has reported any competing interests. RCK has been a consultant for GlaxoSmithKline, Kaiser Permanente, Pfizer, Sanofi-Aventis, Shire Pharmaceuticals, and Wyeth-Ayerst; has served on advisory boards for Eli Lilly & Company and Wyeth-Ayerst; and has had research support for his epidemiological studies from Bristol-Myers Squibb, Eli Lilly & Company, GlaxoSmithKline, Johnson & Johnson Pharmaceuticals, Ortho-McNeil Pharmaceuticals, Pfizer, and Sanofi-Aventis.
Citation: Nock MK, Hwang I, Sampson N, Kessler RC, Angermeyer M, et al. (2009) Cross-National Analysis of the Associations among Mental Disorders and Suicidal Behavior: Findings from the WHO World Mental Health Surveys. PLoS Med 6(8): e1000123. doi:10.1371/journal.pmed.1000123
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