Chronic physical conditions and their association with first onset of suicidal behavior in the world mental health surveys.
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.
Scott
Kate M
KM
Department of Psychological Medicine, Wellington School of Medicine and Health Sciences, Otago University, Wellington South, New Zealand. kate.scott@otago.ac.nz
Hwang
Irving
I
Chiu
Wai-Tat
WT
Kessler
Ronald C
RC
Sampson
Nancy A
NA
Angermeyer
Matthias
M
Beautrais
Annette
A
Borges
Guilherme
G
Bruffaerts
Ronny
R
de Graaf
Ron
R
Florescu
Silvia
S
Fukao
Akira
A
Haro
Josep Maria
JM
Hu
Chiyi
C
Kovess
Viviane
V
Levinson
Daphna
D
Posada-Villa
José
J
Scocco
Paolo
P
Nock
Matthew K
MK
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002908:Chronic Disease / Q000453:epidemiology* / Q000523:psychology; D003431:Cross-Cultural Comparison; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D014943:Global Health; D015658:HIV Infections / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015999:Multivariate Analysis; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*