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War and first onset of suicidality: the role of mental disorders

Published online by Cambridge University Press:  28 February 2012

E. G. Karam ,
M. M. Salamoun ,
Z. N. Mneimneh ,
J. A. Fayyad ,
A. N. Karam ,
R. Hajjar ,
H. Dimassi ,
M. K. Nock  and
R. C. Kessler
E. G. Karam*
Affiliation:
Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University Medical School, Beirut, Lebanon Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
M. M. Salamoun
Affiliation:
Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Z. N. Mneimneh
Affiliation:
Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon Survey Methodology Program, Survey Research Operation, Institute for Social Research, University of Michigan, MI, USA
J. A. Fayyad
Affiliation:
Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University Medical School, Beirut, Lebanon Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
A. N. Karam
Affiliation:
Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University Medical School, Beirut, Lebanon Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
R. Hajjar
Affiliation:
Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
H. Dimassi
Affiliation:
Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon School of Pharmacy, Lebanese American University, Lebanon
M. K. Nock
Affiliation:
Department of Psychology, Harvard University, Cambridge, MA, USA
R. C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
*
*Address for correspondence: E. G. Karam, M.D., IDRAAC, PO Box 166227, Ashrafieh, Lebanon1100 2110. (Email: idraac@idraac.org)
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Abstract

Background

Suicide rates increase following periods of war; however, the mechanism through which this occurs is not known. The aim of this paper is to shed some light on the associations of war exposure, mental disorders, and subsequent suicidal behavior.

Method

A national sample of Lebanese adults was administered the Composite International Diagnostic Interview to collect data on lifetime prevalence and age of onset of suicide ideation, plan, and attempt, and mental disorders, in addition to information about exposure to stressors associated with the 1975–1989 Lebanon war.

Results

The onset of suicide ideation, plan, and attempt was associated with female gender, younger age, post-war period, major depression, impulse-control disorders, and social phobia. The effect of post-war period on each type of suicide outcome was largely explained by the post-war onset of mental disorders. Finally, the conjunction of having a prior impulse-control disorder and either being a civilian in a terror region or witnessing war-related stressors was associated with especially high risk of suicide attempt.

Conclusions

The association of war with increased risk of suicidality appears to be partially explained by the emergence of mental disorders in the context of war. Exposure to war may exacerbate disinhibition among those who have prior impulse-control disorders, thus magnifying the association of mental disorders with suicidality.

Keywords

Mental disorderssuicidewar

Information

Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 10 , October 2012 , pp. 2109 - 2118
Copyright
Copyright © Cambridge University Press 2012

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References

Beautrais, AL, Joyce, PR, Mulder, RT, Fergusson, DM, Deavoll, BJ, Nightingale, SK (1996). Prevalence and comorbidity of mental disorders in persons making serious suicide attempts: a case-control study. American Journal of Psychiatry 153, 1009–1014.Google ScholarPubMed
Borges, G, Benjet, C, Medina-Mora, ME, Orozco, R, Molnar, BE, Nock, MK (2008). Traumatic events and suicide-related outcomes among Mexico City adolescents. Journal of Child Psychology and Psychiatry 49, 654–666.CrossRefGoogle ScholarPubMed
Bosnar, A, Stemberga, V, Cuculic, D, Zamolo, G, Stifter, S, Coklo, M (2004). Suicide rate after the 1991–1995 war in southwestern Croatia. Archives of Medical Research 35, 344–347.CrossRefGoogle ScholarPubMed
Central Administration for Statistics (1998). Conditions de vie ménages en 1997. Beirut, Lebanon.Google Scholar
Cougle, JR, Keough, ME, Riccardi, CJ, Sachs-Ericsson, N (2009). Anxiety disorders and suicidality in the National Comorbidity Survey-Replication. Journal of Psychiatric Research 43, 825–829.CrossRefGoogle ScholarPubMed
Dube, SR, Anda, RF, Felitti, VJ, Chapman, DP, Williamson, DF, Giles, WH (2001). Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study. Journal of the American Medical Association 286, 3089–3096.Google Scholar
Durkheim, E (1951). Suicide: A Study in Sociology (ed. Simpson, G.; translated by J. A. Spaulding and G. Simpson). New York: Free Press.Google Scholar
Efron, B (1988). Logistic regression, survival analysis, and the Kaplan-Meier curve. Journal of the American Statistical Association 83, 414–425.CrossRefGoogle Scholar
Joiner, TJ (2005). Why People Die by Suicide. Cambridge, MA: Harvard University Press.Google Scholar
Karam, EG, Hajjar, R, Salamoun, M (2007). Suicidality in the Arab World Part I: Community Studies. Arab Journal of Psychiatry 18, 99–107.Google Scholar
Karam, EG, Hajjar, R, Salamoun, M (2008 b). Suicidality in the Arab World Part II: Hospital and Governmental studies. Arab Journal of Psychiatry 19, 1–24.Google Scholar
Karam, EG, Mneimneh, ZN, Dimassi, H, Fayyad, JA, Karam, AN, Nasser, SC, Chatterji, S, Kessler, RC (2008 a). Lifetime prevalence of mental disorders in Lebanon: first onset, treatment, and exposure to war. PLoS Medicine 5(4), e61.CrossRefGoogle ScholarPubMed
Karam, EG, Mneimneh, ZN, Karam, AN, Fayyad, JA, Nasser, SC, Chatterji, S, Kessler, RC (2006). Prevalence and treatment of mental disorders in Lebanon: a national epidemiological survey. Lancet 367, 1000–1006.CrossRefGoogle Scholar
Katzelnick, DJ, Kobak, KA, DeLeire, T, Henk, HJ, Greist, JH, Davidson, JR, Schneier, FR, Stein, MB, Helstad, CP (2001). Impact of generalized social anxiety disorder in managed care. American Journal of Psychiatry 158, 1999–2007.CrossRefGoogle ScholarPubMed
Kessler, RC, Ustun, TB (2004). The World Mental Health (WMH) survey initiative version of the WHO-CIDI. International Journal of Methods in Psychiatric Research 13, 95–121.CrossRefGoogle Scholar
Lester, D (1993). The effect of war on suicide rates: a study of France from 1826 to 1913. Euoropean Archives of Psychiatry and Clinical Neuroscience 242, 248–249.Google Scholar
Nock, MK, Borges, G, Bromet, EJ, Alonso, J, Angermeyer, M, Beautrais, A, Bruffaerts, R, Chiu, WT, de Girolamo, G, Gluzman, S, de Graaf, R, Gureje, O, Haro, JM, Huang, Y, Karam, E, Kessler, RC, Lepine, JP, Levinson, D, Medina-Mora, ME, Ono, Y, Posada-Villa, J, Williams, D (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry 192, 98–105.CrossRefGoogle ScholarPubMed
Nock, MK, Hwang, I, Sampson, N, Kessler, RC, Angermeyer, M, Beautrais, A, Borges, G, Bromet, E, Bruffaerts, R, de Girolamo, G, de Graaf, R, Florescu, S, Gureje, O, Haro, JM, Hu, C, Huang, Y, Karam, EG, Kawakami, N, Kovess, V, Levinson, D, Posada-Villa, J, Sagar, R, Tomov, T, Viana, MC, Williams, DR (2009). Cross-national analysis of the associations among mental disorders and suicidal behavior: Findings from the WHO World Mental Health Surveys. PLoS Medicine 6, e1000123.CrossRefGoogle ScholarPubMed
Olfson, M, Guardino, M, Struening, E, Schneier, FR, Hellman, F, Klein, DF (2000). Barriers to the treatment of social anxiety. American Journal of Psychiatry 157, 521–527.Google Scholar
Plutchik, R (1995). Outward and inward directed aggressiveness: The interaction between violence and suicidality. Pharmacopsychiatry 28, 47–57.Google Scholar
Sareen, J, Cox, BJ, Afifi, TO, de Graaf, R, Asmundson, GJ, ten Have, M, Stein, MB (2005). Anxiety disorders and risk for suicide ideation and suicide attempts: a population-based longitudinal study of adults. Archives of General Psychiatry 62, 1249–1257.CrossRefGoogle ScholarPubMed
Schneier, FR, Johnson, J, Hornig, CD, Liebowitz, MR, Weissman, MM (1992). Social Phobia: comorbidity and morbidity in an epidemiological sample. Archives of General Psychiatry 49, 282–288.Google Scholar
Suokas, J, Suominen, K, Isometsa, E, Ostamo, A, Lonnqvist, J (2001). Long-term risk factors for suicide mortality after attempted suicide – findings of a 14-year follow-up study. Acta Psychiatrica Scandinavica 104, 117–121.Google Scholar
Taylor, PJ, Gooding, P, Wood, AM, Tarrier, N (2011). The role of defeat and entrapment in depression, anxiety, and suicide. Psychological Bulletin 137, 391–420.CrossRefGoogle ScholarPubMed
Turner, CF, Ku, L, Rogers, SM, Lindberg, LD, Pleck, JH, Sonenstein, FL (1998). Adolescent sexual behavior, drug use, and violence; increased reporting with computer survey technology. Science 280, 867–873.CrossRefGoogle ScholarPubMed
Wolter, KM (1985). Introduction to Variance Estimation. New York: Springer-Verlag.Google Scholar