Browsing by Author "Nock, Matthew K."

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A Qualitative Examination of the Impact of Suicidal Thoughts and Behavior on Help-Seeking Among University Students in Colombia and Mexico
(Elsevier, 2023) Castro-Ramirez, Franchesca; Paz-Pérez, María Abigail; McGuire, Taylor C.; Rankin, Osiris; García Alfaro, María Carolina; Melchor Audirac, Andres; Gómez Campuzano, Martha Luz; Coady, Parker; Núñez-Delgado, Mauricio; Manana, Jhovelis; Hernández-de la Rosa, Cristiny; Tambedou, Tida; Vergara, Genesis A.; Alvis Barranco, Libia; Cudris-Torres, Lorena; Nock, Matthew K.; Naslund, John A.; Benjet, Corina; Department of Psychology, Harvard University, United States; cbenjet@imp.edu.mx (C. Benjet)
A risk index for 12-month suicide attempts in the National Comorbidity Survey Replication (NCS-R)
(CAMBRIDGE UNIV PRESS, 32 AVENUE OF THE AMERICAS, NEW YORK, NY 10013-2473 USA, 2006) Borges, Guilherme; Angst, Jules; Nock, Matthew K.; Ruscio, Ayelet Meron; Walters, Ellen E.; Kessler, Ronald C.; Inst Nacl Psiquiatria Ramon de la Fuente, Direcc Invest Epidemiol & Psicosociales, Mexico City 14370, DF, Mexico; guibor@imp.edu.mx
Childhood adversities as risk factors for onset and persistence of suicidal behaviour
(ROYAL COLLEGE OF PSYCHIATRISTS, BRITISH JOURNAL OF PSYCHIATRY 17 BELGRAVE SQUARE, LONDON SW1X 8PG, ENGLAND, 2010) Bruffaerts, Ronny; Demyttenaere, Koen; Borges, Guilherme; Maria Haro, Josep; Chiu, Wai Tat; Hwang, Irving; Karam, Elie G.; Kessler, Ronald C.; Sampson, Nancy; Alonso, Jordi; Andrade, Laura Helena; Angermeyer, Matthias; Benjet, Corina; Bromet, Evelyn; De Girolamo, Giovanni; De Graaf, Ron; Florescu, Silvia; Gureje, Oye; Horiguchi, Itsuko; Hu, Chiyi; Kovess, Viviane; Levinson, Daphna; Posada-Villa, José; Sagar, Rajesh; Scott, Kate; Tsang, Adley; Vassilev, Svetlozar M.; Williams, David R.; Nock, Matthew K.; Univ Hosp Gasthuisberg, Dept Psychiat, B-3000 Louvain, Belgium; ronny.bruffaerts@med.kuleuven.be
Background: Suicide is a leading cause of death worldwide, but the precise effect of childhood adversities as risk factors for the onset and persistence of suicidal behaviour (suicide ideation, plans and attempts) are not well understood. Aims: To examine the associations between childhood adversities as risk factors for the onset and persistence of suicidal behaviour across 21 countries worldwide. Method: Respondents from nationally representative samples (n = 55 299) were interviewed regarding childhood adversities that occurred before the age of 18 years and lifetime suicidal behaviour. Results: Childhood adversities were associated with an increased risk of suicide attempt and ideation in both bivariate and multivariate models (odds ratio range 1.2-5.7). The risk increased with the number of adversities experienced, but at a decreasing rate. Sexual and physical abuse were consistently the strongest risk factors for both the onset and persistence of suicidal behaviour, especially during adolescence. Associations remained similar after additional adjustment for respondents' lifetime mental disorder status. Conclusions: Childhood adversities (especially intrusive or aggressive adversities) are powerful predictors of the onset and persistence of suicidal behaviours.
Childhood adversities as risk factors for onset and persistence of suicidal behaviour
(2010) Bruffaerts, Ronny; Demyttenaere, Koen; Borges, Guilherme; Haro, Josep Maria; Chiu, Wai Tat; Hwang, Irving; Karam, Elie G.; Kessler, Ronald C.; Sampson, Nancy; Alonso, Jordi; Andrade, Laura Helena; Angermeyer, Matthias; Benjet, Corina; Bromet, Evelyn; De Girolamo, Giovanni; De Graaf, Ron; Florescu, Silvia; Gureje, Oye; Horiguchi, Itsuko; Hu, Chiyi; Kovess, Viviane; Levinson, Daphna; Posada-Villa, Jose; Sagar, Rajesh; Scott, Kate; Tsang, Adley; Vassilev, Svetlozar M.; Williams, David R.; Nock, Matthew K.; permissions@rcpsych.ac.uk
Chronic Physical Conditions and Their Association With First Onset of Suicidal Behavior in the World Mental Health Surveys
(LIPPINCOTT WILLIAMS & WILKINS, 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA, 2010) Scott, Kate M.; Hwang, Irving; Chiu, Wai-Tat; Kessler, Ronald C.; Sampson, Nancy A.; Angermeyer, Matthias; Beautrais, Annette; Borges, Guilherme; Bruffaerts, Ronny; De Graaf, Ron; Florescu, Silvia; Fukao, Akira; Haro, Josep Maria; Hu, Chiyi; Kovess, Viviane; Levinson, Daphna; Posada-Villa, José; Scocco, Paolo; Nock, Matthew K.; Univ Otago, Dept Psychol Med, Sch Med & Hlth Sci, Wellington, New Zealand; kate.scott@otago.ac.nz
Objective: To investigate the association of a range of temporally prior physical conditions with the subsequent first onset of suicidal ideation, plans, and attempts in large, general population, cross-national sample. The associations between physical conditions and suicidal behavior remain unclear due to sparse data and varied methodology. Methods: Predictive associations between 13 temporally prior physical conditions and first onset of suicidal ideation, plans, and attempts were examined in a 14-country sample (n = 37,915) after controlling for demographic, socioeconomic, and psychosocial covariates, with and without adjustment for mental disorders. Results: Most physical conditions were associated with suicidal ideation in the total sample; high blood pressure, heart attack/stroke, arthritis, chronic headache, other chronic pain, and respiratory conditions were associated with attempts in the total sample; epilepsy, cancer, and heart attack/stroke were associated with planned attempts. Epilepsy was the physical condition most strongly associated with the suicidal outcomes. Physical conditions were especially predictive of suicidality if they occurred early in life. As the number of physical conditions increased, the risk of suicidal outcomes also increased, however the added risk conferred was generally smaller with each additional condition. Adjustment for mental disorders made little substantive difference to these results. Physical conditions were equally predictive of suicidality in higher and lower income countries. Conclusions: The presence of physical conditions is a risk factor for suicidal behavior even in the absence of mental disorder.
Cross-National Analysis of the Associations among Mental Disorders and Suicidal Behavior: Findings from the WHO World Mental Health Surveys
(PUBLIC LIBRARY SCIENCE, 185 BERRY ST, STE 1300, SAN FRANCISCO, CA 94107 USA, 2009) Nock, Matthew K.; Hwang, Irving; Sampson, Nancy; Kessler, Ronald C.; Angermeyer, Matthias; Beautrais, Annette; Borges, Guilherme; Bromet, Evelyn; Bruffaerts, Ronny; De Girolamo, Giovanni; De Graaf, Ron; Florescu, Silvia; Gureje, Oye; Haro, Josep Maria; Hu, Chiyi; Huang, Yueqin; Karam, Elie G.; Kawakami, Norito; Kovess, Viviane; Levinson, Daphna; Posada-Villa, José; Sagar, Rajesh; Tomov, Toma; Viana, María Carmen; Williams, David R.; Harvard Univ, Dept Psychol, Cambridge, MA 02138 USA; nock@wjh.harvard.edu
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.
Cross-National Analysis of the Associations between Traumatic Events and Suicidal Behavior: Findings from the WHO World Mental Health Surveys
(PUBLIC LIBRARY SCIENCE, 185 BERRY ST, STE 1300, SAN FRANCISCO, CA 94107 USA, 2010) Stein, Dan J.; Chiu, Wai Tat; Hwang, Irving; Kessler, Ronald C.; Sampson, Nancy; Alonso, Jordi; Borges, Guilherme; Bromet, Evelyn; Bruffaerts, Ronny; De Girolamo, Giovanni; Florescu, Silvia; Gureje, Oye; He, Yanling; Kovess-Masfety, Viviane; Levinson, Daphna; Matschinger, Herbert; Mneimneh, Zeina; Nakamura, Yosikazu; Ormel, Johan; Posada-Villa, José; Sagar, Rajesh; Scott, Kate M.; Tomov, Toma; Viana, María Carmen; Williams, David R.; Nock, Matthew K.; Groote Schuur Hosp, Dept Psychiat, ZA-7925 Cape Town, South Africa; Kessler@hcp.med.harvard.edu
Background: Community and clinical data have suggested there is an association between trauma exposure and suicidal behavior (i.e., suicide ideation, plans and attempts). However, few studies have assessed which traumas are uniquely predictive of: the first onset of suicidal behavior, the progression from suicide ideation to plans and attempts, or the persistence of each form of suicidal behavior over time. Moreover, few data are available on such associations in developing countries. The current study addresses each of these issues. Methodology/Principal Findings: Data on trauma exposure and subsequent first onset of suicidal behavior were collected via structured interviews conducted in the households of 102,245 (age 18+) respondents from 21 countries participating in the WHO World Mental Health Surveys. Bivariate and multivariate survival models tested the relationship between the type and number of traumatic events and subsequent suicidal behavior. A range of traumatic events are associated with suicidal behavior, with sexual and interpersonal violence consistently showing the strongest effects. There is a dose-response relationship between the number of traumatic events and suicide ideation/attempt; however, there is decay in the strength of the association with more events. Although a range of traumatic events are associated with the onset of suicide ideation, fewer events predict which people with suicide ideation progress to suicide plan and attempt, or the persistence of suicidal behavior over time. Associations generally are consistent across high-, middle-, and low-income countries. Conclusions/Significance: This study provides more detailed information than previously available on the relationship between traumatic events and suicidal behavior and indicates that this association is fairly consistent across developed and developing countries. These data reinforce the importance of psychological trauma as a major public health problem, and highlight the significance of screening for the presence and accumulation of traumatic exposures as a risk factor for suicide ideation and attempt.
Cross-national prevalence and risk factors for suicidal ideation, plans and attempts
(ROYAL COLLEGE OF PSYCHIATRISTS, BRITISH JOURNAL OF PSYCHIATRY 17 BELGRAVE SQUARE, LONDON SW1X 8PG, ENGLAND, 2008) Nock, Matthew K.; Borges, Guilherme; Bromet, Evelyn J.; Alonso, Jordi; Angermeyer, Matthias; Beautrais, Annette; Bruffaerts, Ronny; Chiu, Wai Tat; De Girolamo, Giovanni; Gluzman, Semyon; De Graaf, Ron; Gureje, Oye; Haro, Josep Maria; Huang, Yueqin; Karam, Elie; Kessler, Ronald C.; Lepine, Jean Pierre; Levinson, Daphna; Medina-Mora, María Elena; Ono, Yutaka; Posada-Villa, José; Williams, David; Harvard Univ, Dept Psychol, Cambridge, MA 02138 USA; nock@wjh.harvard.edu
Background: Suicide is a leading cause of death worldwide; however, the prevalence and risk factors for the immediate precursors to suicide - suicidal ideation, plans and attempts - are not well-known, especially in low- and middle-income countries. Aims: To report on the prevalence and risk factors for suicidal behaviours across 17 countries. Method: A total of 84850 adults were interviewed regarding suicidal behaviours and socio-demographic and psychiatric risk factors. Results: The cross-national lifetime prevalence of suicidal ideation, plans, and attempts is 9.2% (s.e.=0.1), 3.1% (s.e.=0.1), and 2.7% (s.e.=0.1). Across all countries, 60% of transitions from ideation to plan and attempt occur within the first year after ideation onset. Consistent cross-national risk factors included being female, younger, less educated, unmarried and having a mental disorder. interestingly, the strongest diagnostic risk factors were mood disorders in high-income countries but impulse control disorders in low- and middle-income countries. Conclusion: There is cross-national variability in the prevalence of suicidal behaviours, but strong consistency in the characteristics and risk factors for these behaviours. These findings have significant implications for the prediction and prevention of suicidal behaviours. Declaration of interests: None. Funding detailed in Acknowledgements.
Lifetime and 12-month treatment for mental disorders and suicidal thoughts and behaviors among first year college students
(John Wiley & Sons, 2019) Bruffaerts, Ronny; Mortier, Philippe; Auerbach, Randy P.; Alonso, Jordi; Hermosillo De la Torre, Alicia E.; Cuijpers, Pim; Demyttenaere, Koen; Ebert, David D.; Green, Jennifer Greif; Hasking, Penelope; Stein, Dan J.; Ennis, Edel; Nock, Matthew K.; Pinder-Amaker, Stephanie; Sampson, Nancy A.; Vilagut, Gemma; Zaslavsky, Alan M.; Kessler, Ronald C.; WHO WMH-ICS Collaborators; Benjet, Corina; Borges, Guilherme; Medina-Mora, María Elena; Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium; ronny.bruffaerts@kuleuven.be
Mental disorder comorbidity and suicidal thoughts and behaviors in the World Health Organization World Mental Health Surveys International College Student initiative
(John Wiley & Sons, 2019) Auerbach, Randy P.; Mortier, Philippe; Bruffaerts, Ronny; Alonso, Jordi; Benjet, Corina; Cuijpers, Pim; Demyttenaere, Koen; Ebert, David D.; Greif Green, Jennifer; Hasking, Penelope; Lee, Sue; Lochner, Christine; McLafferty, Margaret; Nock, Matthew K.; Petukhova, Maria V.; Pinder-Amaker, Stephanie; Rosellini, Anthony J.; Sampson, Nancy A.; Vilagut, Gemma; Zaslavsky, Alan M.; Kessler, Ronald C.; WHO WMH-ICS Collaborators; Borges, Guilherme; Medina-Mora, María Elena; Department of Psychiatry, Columbia University, New York, New York.; rpa2009@columbia.edu (Randy P. Auerbach)
Non-suicidal self-injury among first-year college students and its association with mental disorders: Results from the World Mental Health International College Student (WMH-ICS) Initiative
(Cambridge University Press, 2023) Kiekens, Glenn; Hasking, Penelope; Bruffaerts, Ronny; Alonso, Jordi; Auerbach, Randy P.; Bantjes, Jason; Benjet, Corina; Boyes, Mark; Chiu, Wai Tat; Claes, Laurence; Cuijpers, Pim; Ebert, David D.; Mak, Arthur; Mortier, Philippe; O’Neill, Siobhan; Sampson, Nancy A.; Stein, Dan J.; Vilagut, Gemma; Nock, Matthew K.; Kessler, Ronald C.; WHO World Mental Health International college student (WMH-ICS) collaborators; Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium; Glenn.Kiekens@kuleuven.be (Glenn Kiekens)
Psychiatric disorders, comorbidity, and suicidality in Mexico
(Elsevier Science BV, PO Box 211, 1000 AE Amsterdam, Netherlands, 2010) Borges, Guilherme; Nock, Matthew K.; Medina-Mora, María Elena; Hwang, Irving; Kessler, Ronald C.; Inst Nacl Psiquiatria Ramon de la Fuente, Direcc Invest Epidemiol & Psicosociales, Mexico City 14370, DF, Mexico; guibor@imp.edu.mx
Background: Prior studies have reported that psychiatric disorders are among the strongest predictors of suicidal behavior (i.e., suicide ideation, plans, and attempts). However, surprisingly little is known about the independent associations between each disorder and each suicidal behavior due to a failure to account for comorbidity. Methods: This study used data from a representative sample of 5782 respondents participating in the Mexican National Comorbidity Survey (2001-2002) to examine the unique associations between psychiatric disorders and suicidality. Results: A prior psychiatric disorder was present in 48.8% of those with a suicide ideation and in 65.2% of those with an attempt. Discrete-time survival models adjusting for comorbidity revealed that conduct disorder and alcohol abuse/dependence were the strongest predictors of a subsequent suicide attempt. Most disorders predicted suicidal ideation but few predicted the transition from ideation to a suicide plan or attempt. Limitations: M-NCS is a household survey that excluded homeless and institutionalized people, and the diagnostic instrument used did not include an assessment of all DSM-IV disorders which would increase the comorbidity discussed here. Conclusions: These results reveal a complex pattern of associations in which diverse psychiatric disorders impact different parts of the pathway to suicide attempts. These findings will help inform clinical and public health efforts aimed at suicide prevention in Mexico and other developing countries. (C) 2009 Elsevier B.V. All rights reserved.
Risk factors for the incidence and persistence of suicide-related outcomes: A 10-year follow-up study using the National Comorbidity Surveys
(Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA, 2008) Borges, Guilherme; Angst, Jules; Nock, Matthew K.; Meron Ruscio, Ayelet; Kessler, Ronald C.; Inst Nacl Psiquiatria Ramon de la Fuente, Direcc Invest Epidemiol & Psicosociales, Mexico City 14370, DF, Mexico; guibor@imp.edu.mx
Background: We report prospective associations of baseline risk factors with the first onset and persistence of suicide-related outcomes (SROs; ideation, plans, gestures, and attempts) over a 10-year interval among respondents who participated in both the 1990-02 National Comorbidity Survey (NCS) and the 2000-02 National Comorbidity Survey follow-up (NCS-2). Methods: A total of 5001 NCS respondents were re-interviewed (87.6% of baseline sample) in the NCS-2. Three sets of baseline (NCS) risk factors were considered as predictors of the first onset and persistence of SROs: socio-demographics, lifetime DSM-III-R disorders, and SROs. Results: New onsets included 6.2% suicide ideation, 2.3% plan, 0.7% gesture, and 0.9% attempts. More than one-third of respondents with a baseline history of suicide ideation continued to have suicide ideation at some time over the intervening decade. Persistence was lower for other SROs. The strongest predictors of later SROs were baseline SROs. Prospective associations of baseline mental disorders with later SROs were largely limited to the onset and persistence of ideation. Limitations: Although data were gathered prospectively, they were based on retrospective reports at both baseline and follow-up. Conclusions: Baseline history of SROs explained much of the association of mental disorders with later SROs. It is important clinically to note that many of the risk factors known to predict onset of SROs also predict persistence of SROs. (C) 2007 Elsevier B.V. All rights reserved.
Service use among Mexico City adolescents with suicidality
(ELSEVIER SCIENCE BV, PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS, 2010) Borges, Guilherme; Benjet, Corina; Medina-Mora, María Elena; Orozco, Ricardo; Familiar, Itziar; Nock, Matthew K.; Wang, Philip S.; Inst Nacl Psiquiatria Ramon de la Fuente, Direcc Invest Epidemiol & Psicosociales, Mexico City 14370, DF, Mexico; guibor@imp.edu.mx
Background: We report the lifetime and 12-month prevalence and associations of mental health treatment among Mexican adolescents with suicide-related outcomes (SROs; including ideation, plans, gestures and attempts). Methods: A representative multistage probability household survey of 3005 adolescents aged 12 to 17 years residing in the Mexico City Metropolitan Area was carried out in 2005. Discrete-time survival analyses were used to assess the relationships between SROs and receiving treatment for emotional, alcohol, or drug problems. Results: The prevalence of lifetime service use among respondents with SROs was 35% for those with ideation only, 44% for those with ideation and plan, 49% for those with gesture and 50% for those with attempt; the prevalence of 12-month service use was 10%, 24%, 6% and 21%, respectively. Timing between onset of SRO and receiving treatment for emotional, alcohol, or drug problems showed that about 50% of adolescents will have contact with a service provider before developing any SRO. Healthcare professionals were the most likely to be consulted, followed by school-based programs. Limitations: This survey was limited to adolescents living in one of the largest metropolitan areas in the world and the analyses used data on retrospectively reported ages of onset that are subject to recall errors. Conclusions: Most suicidal adolescents do not receive treatment, and many adolescents develop their suicidality in spite of prior contacts with service providers. Interventions to increase treatment, prevention, and monitoring are sorely needed for this vulnerable population. (C) 2009 Elsevier B.V. All rights reserved.
Smoking and suicidal behaviors in the national comorbidity survey: Replication
(LIPPINCOTT WILLIAMS & WILKINS, 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA, 2007) Kessler, Ronald C.; Berglund, Patricia A.; Borges, Guilherme; Castilla-Puentes, Ruby C.; Glantz, Meyer D.; Jaeger, Savina A.; Merikangas, Kathleen R.; Nock, Matthew K.; Russo, Leo J.; Stang, Paul E.; Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA; kessler@hcp.med.harvard.edu
Controversy exists about the role of mental disorders in the consistently documented association between smoking and suicidal behavior. This controversy is addressed here with data from the nationally representative National Comorbidity Survey-Replication (NCS-R). Assessments were made of 12-month smoking, suicidal behaviors (ideation, plans, attempts), and DSM-IV disorders (anxiety, mood, impulse-control, and substance use disorders). Statistically significant odds ratios (2.9 -3.1) were found between 12-month smoking and 12-month suicidal behaviors. However, the associations of smoking with the outcomes became insignificant with controls for DSM-IV mental disorders. Although clear adjudication among contending hypotheses about causal mechanisms cannot be made from the cross-sectional NCS-R data, the results make it clear that future research on smoking and suicidal behaviors should focus more centrally than previous research on mental disorders either as common causes, markers, or mediators.
Suicide and Suicidal Behavior
(OXFORD UNIV PRESS INC, JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA, 2008) Nock, Matthew K.; Borges, Guilherme; Bromet, Evelyn J.; Cha, Christine B.; Kessler, Ronald C.; Lee, Sing; Harvard Univ, Dept Psychol, Cambridge, MA 02138 USA; nock@wjh.harvard.edu
Suicidal behavior is a leading cause of injury and death worldwide. Information about the epidemiology of such behavior is important for policy-making and prevention. The authors reviewed government data on suicide and suicidal behavior and conducted a systematic review of studies on the epidemiology of suicide published from 1997 to 2007. The authors' aims were to examine the prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally. The data revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors. Suicide is more prevalent among men, whereas nonfatal suicidal behaviors are more prevalent among women and persons who are young, are unmarried, or have a psychiatric disorder. Despite an increase in the treatment of suicidal persons over the past decade, incidence rates of suicidal behavior have remained largely unchanged. Most epidemiologic research on suicidal behavior has focused on patterns and correlates of prevalence. The next generation of studies must examine synergistic effects among modifiable risk and protective factors. New studies must incorporate recent advances in survey methods and clinical assessment. Results should be used in ongoing efforts to decrease the significant loss of life caused by suicidal behavior.
The epidemiology of suicide-related outcomes in Mexico
(GUILFORD PUBLICATIONS INC, 72 SPRING STREET, NEW YORK, NY 10012 USA, 2007) Borges, Guilherme; Nock, Matthew K.; Medina-Mora, María Elena; Benjet, Corina; Lara, Carmen; Chiu, Wai Tat; Kessler, Ronald C.; Inst Nacl Psiquiatria Ramon de la Fuente, Direcc Invest Epidemiol & Psicosociales, Mexico City 14370, DF, Mexico; guibor@imp.edu.mx
Nationally representative data from the Mexican National Comorbidity Survey are presented on the lifetime prevalence and age-of-onsct (AOO) distributions of suicide ideation, plan and attempt and on temporally prior demographic and DSM-IV psychiatric risk factors. Lifetime ideation was reported by 8.1% of respondents, while 3.2% reported a lifetime plan and 2.7% a lifetime suicide attempt. Onset of all outcomes was highest in adolescence and early adulthood. The risk of transition from suicide ideation to plan and attempt was highest within the first year of onset of ideation. The presence of one or more temporally prior DSM-IV/CIDI (Composite International Diagnostic Instrument) disorder was strongly related to each suicide-related outcome. Suicidal outcomes are prevalent, have an early AOO, and are strongly related to temporally prior mental disorders in Mexico. Given the early AOO, intervention efforts need to focus more than currently on children and adolescents with mental disorders to be effective in prevention.
Traumatic events and suicide-related outcomes among Mexico City adolescents
(Wiley-Blackwell, Commerce Place, 350 Main ST, Malden 02148, MA USA, 2008) Borges, Guilherme; Benjet, Corina; Medina-Mora, María Elena; Orozco, Ricardo; Molnar, Beth E.; Nock, Matthew K.; Inst Nacl Psiquiatria Ramon de la Fuente, Direcc Invest Epidemiol & Psicosociales, Mexico City 14370, DF, Mexico; guibor@imp.edu.mx
Background: We report the prevalence and associations between traumatic events and suicidal ideation, suicide plans and suicide attempts among Mexican adolescents. Methods: The data are from a representative multistage probability household survey of 3,005 adolescents aged 12 to 17 years residing in the Mexico City Metropolitan Area that was carried out in 2005. We used discrete time survival analyses to model the net impact of retrospectively reported prior occurrence of traumatic events on ideation, plans and attempts, taking into account the onset of psychiatric disorders. Results: Prevalence of suicidality was high among respondents with traumatic events, ranging from a 43% prevalence of suicidal ideation among those with a history of 'Being raped' to a 25% prevalence of suicide attempts among those that reported 'Purposely injured, tortured or killed someone.' In cross-sectional estimates, any traumatic event was associated with an increase of 3.2 times the odds of suicide ideation, 5.1 times the odds of a plan and 6.6 times the odds of an attempt. Number of events was also associated with increasing suicidality such that those with three or more events were 13.7 times more likely to report a suicide attempt than those with none. Multivariate discrete time survival models that took into account a large number of demographic, suicide-related and psychiatric disorder variables reduced in strength but did not alter these basic relationships. Conclusions: We conclude that traumatic events such as rape and sexual assault have a profound impact upon suicidality and that this relationship is not entirely explained by the onset of psychiatric disorders. Comprehensive interventions for adolescent victims of traumatic events, especially those with a history of cumulative events, should include, but not be restricted to, treatment of any associated psychiatric disorder.
Twelve-Month Prevalence of and Risk Factors for Suicide Attempts in the World Health Organization World Mental Health Surveys
(PHYSICIANS POSTGRADUATE PRESS, P O BOX 752870, MEMPHIS, TN 38175-2870 USA, 2010) Borges, Guilherme; Nock, Matthew K.; Haro Abad, Josep M.; Hwang, Irving; Sampson, Nancy A.; Alonso, Jordi; Andrade, Laura Helena; Angermeyer, Matthias C.; Beautrais, Annette; Bromet, Evelyn; Bruffaerts, Ronny; De Girolamo, Giovanni; Florescu, Silvia; Gureje, Oye; Hu, Chiyi; Karam, Elie G.; Kovess-Masfety, Viviane; Lee, Sing; Levinson, Daphna; Medina-Mora, María Elena; Ormel, Johan; Posada-Villa, José; Sagar, Rajesh; Tomov, Toma; Uda, Hidenori; Williams, David R.; Kessler, Ronald C.; Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA; Kessler@hcp.med.harvard.edu
Objective: Although suicide is a leading cause of death worldwide, clinicians and researchers lack a data-driven method to assess the risk of suicide attempts. This study reports the results of an analysis of a large cross-national epidemiologic survey database that estimates the 12-month prevalence of suicidal behaviors, identifies risk factors for suicide attempts, and combines these factors to create a risk index for 12-month suicide attempts separately for developed and developing countries. Method: Data come from the World Health Organization (WHO) World Mental Health (WMH) Surveys (conducted 2001-2007), in which 108,705 adults from 21 countries were interviewed using the WHO Composite International Diagnostic Interview. The survey assessed suicidal behaviors and potential risk factors across multiple domains, including socio-demographic characteristics, parent psychopathology, childhood adversities, DSM-IV disorders, and history of suicidal behavior. Results: Twelve-month prevalence estimates of suicide ideation, plans, and attempts are 2.0%, 0.6%, and 0.3%, respectively, for developed countries and 2.1%, 0.7%, and 0.4%, respectively, for developing countries. Risk factors for suicidal behaviors in both developed and developing countries include female sex, younger age, lower education and income, unmarried status, unemployment, parent psychopathology, childhood adversities, and presence of diverse 12-month DSM-IV mental disorders. Combining risk factors from multiple domains produced risk indices that accurately predicted 12-month suicide attempts in both developed and developing countries (area under the receiver operating characteristic curve = 0.74-0.80). Conclusions: Suicidal behaviors occur at similar rates in both developed and developing countries. Risk indices assessing multiple domains can predict suicide attempts with fairly good accuracy and may be useful in aiding clinicians in the prediction of these behaviors. J Clin Psychiatry 2010;71(12):1617-1628 (C) Copyright 2010 Physicians Postgraduate Press, Inc.