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Many Mental Disorders Increase The Chance Of Suicidal Thoughts

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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.”

PLoS Med 6(8): e1000123. doi:10.1371/journal.pmed.1000123
Cross-National Analysis of the Associations among Mental Disorders and Suicidal Behavior: Findings from the WHO World Mental Health Surveys.
ock MK, Hwang I, Sampson N, Kessler RC, Angermeyer M, et al. (2009)

Abstract
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 FindingsData 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.
ConclusionsThis 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.

Written by huehueteotl

August 14, 2009 at 7:42 am

Posted in Psychology

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