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Cross-national prevalence and risk factors for suicidal ideation, plans and attempts

  • Matthew K. Nock (a1), Guilherme Borges (a2), Evelyn J. Bromet (a3), Jordi Alonso (a4), Matthias Angermeyer (a5), Annette Beautrais (a6), Ronny Bruffaerts (a7), Wai Tat Chiu (a8), Giovanni de Girolamo (a9), Semyon Gluzman (a10), Ron de Graaf (a11), Oye Gureje (a12), Josep Maria Haro (a13), Yueqin Huang (a14), Elie Karam (a15), Ronald C. Kessler (a1), Jean Pierre Lepine (a16), Daphna Levinson (a17), Maria Elena Medina-Mora (a2), Yutaka Ono (a18), José Posada-Villa (a19) and David Williams (a20)...
Abstract
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 84 850 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.

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Copyright
Corresponding author
Matthew K. Nock, PhD, Department of Psychology, Harvard University, 33 Kirkland Street, 1280 Cambridge, MA 02138, USA. Email: nock@wjh.harvard.edu
References
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1 World Health Organization. Prevention of Suicide: Guidelines for the Formulation and Implementation of National Strategies. World Health Organization, 1996.
2 Vijayakumar, L, Nagaraj, K, Pirkis, J, Whiteford, H. Suicide in developing countries 1: frequency, distribution, and association with socioeconomic indicators. Crisis 2005; 26: 104–11.
3 Moscicki, EK. Epidemiology of suicide. In The Harvard Medical School Guide to Suicide Assessment and Intervention (ed Jacobs, D.G.): 4051. Jossey-Bass, 1999.
4 Kessler, RC, Berglund, P, Borges, G, Nock, MK, Wang, PS. Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. J Am Med Assoc 2005; 293: 2487–95.
5 Weissman, MM, Bland, RC, Canino, GJ, Greenwald, S, Hwu, HG, Joyce, PR, Karam, EG, Lee, CK, Lellouch, J, Lepine, JP, Newman, SC, Rubio-Stipec, M, Wells, JE, Wickramaratne, PJ, Wittchen, HU, Yeh, EK. Prevalence of suicide ideation and suicide attempts in nine countries. Psychol Med 1999; 29: 917.
6 Kessler, RC, Borges, G, Walters, EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry 1999; 56: 617–26.
7 Vijayakumar, L. Suicide prevention: the urgent need in developing countries. World Psychiatry 2004; 3: 158–9.
8 Phillips, MR, Yang, G, Zhang, Y, Wang, L, Ji, H, Zhou, M. Risk factors for suicide in China: a national case-control psychological autopsy study. Lancet 2002; 360: 1728–36.
9 Mann, JJ, Apter, A, Bertolote, J, Beautrais, A, Currier, D, Haas, A, Hegerl, U, Lonnqvist, J, Malone, K, Marusic, A, Mehlum, L, Patton, G, Phillips, M, Rutz, W, Rihmer, Z, Schmidtke, A, Shaffer, D, Silverman, M, Takahashi, Y, Varnik, A, Wasserman, D, Yip, P, Hendin, H. Suicide prevention strategies: a systematic review. J Am Med Assoc 2005; 294: 2064–74.
10 Demyttenaere, K, Bruffaerts, R, Posada-Villa, J, Gasquet, I, Kovess, V, Lepine, JP, Angermeyer, MC, Bernert, S, de Girolamo, G, Morosini, P, Polidori, G, Kikkawa, T, Kawakami, N, Ono, Y, Takeshima, T, Uda, H, Karam, EG, Fayyad, JA, Karam, AN, Mneimneh, ZN, Medina-Mora, ME, Borges, G, Lara, C, de Graaf, R, Ormel, J, Gureje, O, Shen, Y, Huang, Y, Zhang, M, Alonso, J, Haro, JM, Vilagut, G, Bromet, EJ, Gluzman, S, Webb, C, Kessler, RC, Merikangas, KR, Anthony, JC, Von Korff, MR, Wang, PS, Brugha, TS, Aguilar-Gaxiola, S, Lee, S, Heeringa, S, Pennell, BE, Zaslavsky, AM, Ustun, TB, Chatterji, S; on behalf of the WHO World Mental Health Survey Consortium. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004; 291: 2581–90.
11 Platt, S, Bille-Brahe, U, Kerkh of, A, Schmidtke, A, Bjerke, T, Crepet, P, De Leo, D, Haring, C, Lonnqvist, J, Michel, K, Philippe, A, Pommereau, X, Querejeta, I, Salander-Renberg, E, Temesvary, B, Wasserman, D, Sampaio Faria, J. Parasuicide in Europe: the WHO/EURO multicentre study on parasuicide. I. Introduction and preliminary analysis for 1989. Acta Psychiatr Scand 1992; 85: 97104.
12 Bertolote, JM, Fleischmann, A, De Leo, D, Bolhari, J, Botega, N, De Silva, D, Tran Thi Thanh, H, Phillips, M, Schlebusch, L, varnik, A, Vijayakumar, L, Wasserman, D. Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey. Psychol Med 2005; 35: 1457–65.
13 Alonso, J, Angermeyer, MC, Bernert, S, Bruffaerts, R, Brugha, TS, Bryson, H, de Girolamo, G, Graaf, R, Demyttenaere, K, Gasquet, I, Haro, JM, Katz, SJ, Kessler, RC, Kovess, V, Lépine, JP, Ormel, J, Polidori, G, Russo, LJ, Vilagut, G, Almansa, J, Arbabzadeh-Bouchez, S, Autonell, J, Bernal, M, Buist-Bouwman, MA, Codony, M, Domingo-Salvany, A, Ferrer, M, Joo, SS, Martínez-Alonso, M, Matschinger, H, Mazzi, F, Morgan, Z, Morosini, P, Palacín, C, Romera, B, Taub, N, Vollebergh, WA; on behalf of the ESEMeD/MHEDEA 2000 Investigators, European Study of the Epidemiology of Mental Disorders ESEMeD Project. Sampling and methods of the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004; 420: 820.
14 World Bank. World Development Indicators 2003. The World Bank, 2003.
15 Kessler, RC, Merikangas, KR. The National Comorbidity Survey Replication (NCS–R): background and aims. Int J Methods Psychiatr Res 2004; 13: 60–8.
16 Kessler, RC, Ustun, TB. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004; 13: 93121.
17 Turner, CF, Ku, L, Rogers, SM, Lindberg, LD, Pleck, JH, Sonenstein, FL. Adolescent sexual behaviour, drug use, and violence: increased reporting with computer survey technology. Science 1998; 280: 867–73.
18 First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM–IV–TR Axis I Disorders, Research Version, Non-Patient Edition (SCID–I/NP). Biometrics Research, New York State Psychiatric Institute, 2002.
19 Kessler, RC, Berglund, P, Demler, O, Jin, R, Walters, EE. Lifetime prevalence and age-of-onset distributions of DSM–IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62: 593602.
20 Haro, JM, Arbabzadeh-Bouchez, S, Brugha, TS, de Girolamo, G, Guyer, ME, Jin, R, Lepine, JP, Mazzi, F, Reneses, B, Vilagut, G, Sampson, NA, Kessler, RC. Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health Surveys. Int J Methods Psychiatr Res 2006; 15: 167180.
21 Efron, B. Logistic regression, survival analysis, and the Kaplan Meier curve. J Am Sociol Assoc 1988; 83: 414–25.
22 Wolter, K. Introduction to Variance Estimation. Springer-Verlag, 1985.
23 SUDAAN: Professional Software for Survey Data Analysis computer program. 8.0.1 Version. Research Triangle Institute, 2002.
24 Eddleston, M, Konradsen, F. Commentary: time for a re-assessment of the incidence of intentional and unintentional injury in India and South East Asia. Int J Epidemiol 2007; 36: 208–11.
25 Brewin, CR, Andrews, B, Gotlib, IH. Psychopathology and early experience: a reappraisal of retrospective reports. Psychol Bull 1993; 113: 8298.
26 Hardt, J, Rutter, M. Validity of adult retrospective reports of adverse childhood experiences: review of the evidence. J Child Psychol Psychiatry 2004; 45: 260–73.
27 Schlesselman, JJ. Case–Control Studies: Design, Conduct, and Analysis. Oxford University Press, 1982.
28 Kendler, KS, Gallagher, TJ, Abelson, JM, Kessler, RC. Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. The National Comorbidity Survey. Arch Gen Psychiatry 1996; 53: 1022–31.
29 Phillips, MR, Yang, G, Li, S, Li, Y. Suicide and the unique prevalence pattern of schizophrenia in mainland China: a retrospective observational study. Lancet 2004; 364: 1062–8.
30 Cavanagh, JT, Carson, AJ, Sharpe, M, Lawrie, SM. Psychological autopsy studies of suicide: a systematic review. Psychol Med 2003; 33: 395405.
31 Mann, JJ, Waternaux, C, Haas, GL, Malone, KM. Toward a clinical model of suicidal behaviour in psychiatric patients. Am J Psychiatry 1999; 156: 181–9.
32 Crawford, MJ, Thomas, O, Khan, N, Kulinskaya, E. Psychosocial interventions following self-harm: systematic review of their efficacy in preventing suicide. Br J Psychiatry 2007; 190: 11–7.
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Cross-national prevalence and risk factors for suicidal ideation, plans and attempts

  • Matthew K. Nock (a1), Guilherme Borges (a2), Evelyn J. Bromet (a3), Jordi Alonso (a4), Matthias Angermeyer (a5), Annette Beautrais (a6), Ronny Bruffaerts (a7), Wai Tat Chiu (a8), Giovanni de Girolamo (a9), Semyon Gluzman (a10), Ron de Graaf (a11), Oye Gureje (a12), Josep Maria Haro (a13), Yueqin Huang (a14), Elie Karam (a15), Ronald C. Kessler (a1), Jean Pierre Lepine (a16), Daphna Levinson (a17), Maria Elena Medina-Mora (a2), Yutaka Ono (a18), José Posada-Villa (a19) and David Williams (a20)...
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