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."
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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.hcp.med.harvard.edu/wmh/.
The Chinese World Mental Health Survey Initiative is supported by the
Pfizer Foundation. The Colombian National Study of Mental Health (NSMH)
is supported by the Ministry of Social Protection, with supplemental
support from the Saldarriaga Concha Foundation. The ESEMeD project is
funded by the European Commission (contracts QLG5-1999-01042; SANCO
2004123); the Piedmont Region (Italy); Fondo de I nvestigacion
Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028);
Ministerio de Ciencia y Tecnologı´a, Spain (SAF 2000-158-CE);
Departament de Salut, Generalitat de Catalunya, Spain, RETICS RD06/0011
REM-TAP; and other local agencies, and by an unrestricted educational
grant from GlaxoSmithKline. The Israel National Health Survey is funded
by the Ministry of Health with support from the Israel National
Institute for Health Policy and Health Services Research and the
National Insurance Institute of Israel. The World Mental Health Japan
(WMHJ) Survey is supported by the Grant for Research on Psychiatric and
Neurological Diseases and Mental Health (H13-SHOGAI-023,
H14-TOKUBETSU-026, H16-KOKORO-013) from the Japan Ministry of Health,
Labour and Welfare. The Lebanese National Mental Health Survey (LNMHS)
is supported by the Lebanese Ministry of Public Health; the WHO
(Lebanon); the Fogarty International Center and anonymous private
donations to IDRAAC, Lebanon; and unrestricted grants from Janssen
Cilag, Eli Lilly, GlaxoSmithKline, Roche, and Novartis. The Mexican
National Comorbidity Survey (MNCS) is supported by The National
Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the
National Council on Science and Technology (CONACyT-G30544- H), with
supplemental support from the PanAmerican Health Organization (PAHO).
Te Rau Hinengaro: The New Zealand Mental Health Survey (NZMHS) is
supported by the New Zealand Ministry of Health, Alcohol Advisory
Council, and the Health Research Council. The Nigerian Survey of Mental
Health and Wellbeing (NSMHW) is supported by the WHO (Geneva), the WHO
(Nigeria), and the Federal Ministry of Health, Abuja, Nigeria. The
South Africa Stress and Health Study (SASH) is supported by the US
National Institute of Mental Health (R01-MH059575) and National
Institute of Drug Abuse with supplemental funding from the Sout h
African Department of Health and the University of Michigan. The
Ukraine Comorbid Mental Disorders during Periods of Social Disruption
(CMDPSD) study is funded by the US National Institute of Mental Health
(RO1-MH61905). The US National Comorbidity Survey Replication (NCS-R)
is supported by the National Institute of Mental Health (NIMH;
U01-MH60220) with supplemental support from the National Institute of
Drug Abuse (NIDA), the Substance Abuse and Mental Health Services
Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF;
Grant 044708), and the John W. Alden Trust. RCK, as principal
investigator, had full access to all of the data in the study and takes
responsibility for the integrity of the data and the accuracy of the
data analysis. The funders had no role in study design, data collection
and analysis, decision to publish, or preparation of the manuscript.
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
Editors' Summary: http://www.plos.org/press/plme-06-08-nock-summary.pdf
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=1000123
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-06-08-nock.pdf
CONTACT:
Matthew Nock
Harvard University
Department of Psychology
33 Kirkland Street, 1280
Cambridge, MA 02138
United States of America
+1 617 496-4484
+1 617-496-9462 (fax)
nock@wjh.harvard.edu
About PLoS Medicine
PLoS Medicine
is an open access, freely available international medical journal. It
publishes original research that enhances our understanding of human
health and disease, together with commentary and analysis of important
global health issues. For more information, visit http://www.plosmedicine.org
About the Public Library of Science
The
Public Library of Science (PLoS) is a non-profit organization of
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information, visit http://www.plos.org
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