title: Chronic physical conditions and their association with first onset of suicidal behavior in the world mental health surveys.
abstract: 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.
authors.affiliation: Department of Psychological Medicine, Wellington School of Medicine and Health Sciences, Otago University, Wellington South, New Zealand. kate.scott@otago.ac.nz
authors.forename: Kate M
authors.initials: KM
authors.lastname: Scott
authors.forename: Irving
authors.initials: I
authors.lastname: Hwang
authors.forename: Wai-Tat
authors.initials: WT
authors.lastname: Chiu
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Sampson
authors.forename: Matthias
authors.initials: M
authors.lastname: Angermeyer
authors.forename: Annette
authors.initials: A
authors.lastname: Beautrais
authors.forename: Guilherme
authors.initials: G
authors.lastname: Borges
authors.forename: Ronny
authors.initials: R
authors.lastname: Bruffaerts
authors.forename: Ron
authors.initials: R
authors.lastname: de Graaf
authors.forename: Silvia
authors.initials: S
authors.lastname: Florescu
authors.forename: Akira
authors.initials: A
authors.lastname: Fukao
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
authors.forename: Chiyi
authors.initials: C
authors.lastname: Hu
authors.forename: Viviane
authors.initials: V
authors.lastname: Kovess
authors.forename: Daphna
authors.initials: D
authors.lastname: Levinson
authors.forename: José
authors.initials: J
authors.lastname: Posada-Villa
authors.forename: Paolo
authors.initials: P
authors.lastname: Scocco
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Nock
mesh_terms: 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*