Twelve-month prevalence of and risk factors for suicide attempts in the World Health Organization World Mental Health Surveys.
OBJECTIVE
Although suicide is a leading cause of death worldwide, clinicians and researchers lack a data-driven method to assess the risk of suicide attempts. This study reports the results of an analysis of a large cross-national epidemiologic survey database that estimates the 12-month prevalence of suicidal behaviors, identifies risk factors for suicide attempts, and combines these factors to create a risk index for 12-month suicide attempts separately for developed and developing countries.


METHODS
Data come from the World Health Organization (WHO) World Mental Health (WMH) Surveys (conducted 2001-2007), in which 108,705 adults from 21 countries were interviewed using the WHO Composite International Diagnostic Interview. The survey assessed suicidal behaviors and potential risk factors across multiple domains, including sociodemographic characteristics, parent psychopathology, childhood adversities, DSM-IV disorders, and history of suicidal behavior.


RESULTS
Twelve-month prevalence estimates of suicide ideation, plans, and attempts are 2.0%, 0.6%, and 0.3%, respectively, for developed countries and 2.1%, 0.7%, and 0.4%, respectively, for developing countries. Risk factors for suicidal behaviors in both developed and developing countries include female sex, younger age, lower education and income, unmarried status, unemployment, parent psychopathology, childhood adversities, and presence of diverse 12-month DSM-IV mental disorders. Combining risk factors from multiple domains produced risk indices that accurately predicted 12-month suicide attempts in both developed and developing countries (area under the receiver operating characteristic curve = 0.74-0.80).


CONCLUSIONS
Suicidal behaviors occur at similar rates in both developed and developing countries. Risk indices assessing multiple domains can predict suicide attempts with fairly good accuracy and may be useful in aiding clinicians in the prediction of these behaviors.
Borges
Guilherme
G
National Institute of Psychiatry, Mexico City, Mexico.
Nock
Matthew K
MK
Haro Abad
Josep M
JM
Hwang
Irving
I
Sampson
Nancy A
NA
Alonso
Jordi
J
Andrade
Laura Helena
LH
Angermeyer
Matthias C
MC
Beautrais
Annette
A
Bromet
Evelyn
E
Bruffaerts
Ronny
R
de Girolamo
Giovanni
G
Florescu
Silvia
S
Gureje
Oye
O
Hu
Chiyi
C
Karam
Elie G
EG
Kovess-Masfety
Viviane
V
Lee
Sing
S
Levinson
Daphna
D
Medina-Mora
Maria Elena
ME
Ormel
Johan
J
Posada-Villa
Jose
J
Sagar
Rajesh
R
Tomov
Toma
T
Uda
Hidenori
H
Williams
David R
DR
Kessler
Ronald C
RC
D000328:Adult; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D019049:Developed Countries / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data; D039721:Diagnostic and Statistical Manual of Mental Disorders; D016021:Epidemiologic Studies; D005260:Female; D014943:Global Health; D006306:Health Surveys / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007391:International Cooperation; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D010290:Parents / Q000523:psychology; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012923:Social Class; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D014944:World Health Organization / Q000458:organization & administration*
Psychol Med. 2006 Dec;36(12):1747-57
16938149
J Interpers Violence. 2004 Sep;19(9):1063-74
15296617
Psychol Assess. 2004 Sep;16(3):267-75
15456382
J Clin Psychiatry. 2008 Jan;69(1):23-31
18312034
Arch Gen Psychiatry. 1999 Jul;56(7):617-26
10401507
Am J Psychiatry. 1990 Sep;147(9):1189-94
2104515
Psychol Med. 2005 Oct;35(10):1457-65
16164769
Arch Gen Psychiatry. 1991 May;48(5):418-22
2021294
Epidemiol Rev. 2008;30:133-54
18653727
Arch Gen Psychiatry. 2002 Aug;59(8):741-9
12150651
Br J Psychiatry. 2008 Feb;192(2):98-105
18245022
Am J Psychiatry. 2005 Mar;162(3):633
15741501
J Am Acad Child Adolesc Psychiatry. 2001 Jul;40(7 Suppl):24S-51S
11434483
Psychol Med. 1997 Sep;27(5):1101-19
9300515
J Consult Clin Psychol. 2008 Feb;76(1):92-103
18229987
N Engl J Med. 2005 Oct 13;353(15):1621-3
16221788
Int J Methods Psychiatr Res. 2006;15(4):167-80
17266013
Acta Psychiatr Scand. 1996 May;93(5):327-38
8792901
Psychol Med. 1999 Jan;29(1):9-17
10077289
Am J Psychiatry. 2003 Nov;160(11 Suppl):1-60
14649920
J Nerv Ment Dis. 1991 Nov;179(11):689-93
1940893
JAMA. 2001 Dec 26;286(24):3089-96
11754674
Am J Psychiatry. 2005 Sep;162(9):1672-9
16135627
Arch Gen Psychiatry. 1977 Oct;34(10):1229-35
911222
Int J Methods Psychiatr Res. 2004;13(2):93-121
15297906
J Affect Disord. 2004 Oct 1;82(1):43-52
15465575
JAMA. 2005 May 25;293(20):2487-95
15914749
Arch Gen Psychiatry. 1996 Nov;53(11):1022-31
8911225
Arch Gen Psychiatry. 1996 Apr;53(4):339-48
8634012
J Am Acad Child Adolesc Psychiatry. 2003 Apr;42(4):386-405
12649626
J Consult Clin Psychol. 2000 Jun;68(3):371-7
10883553
Br J Psychiatry. 1997 Jun;170:541-8
9330021
Am J Med Genet C Semin Med Genet. 2005 Feb 15;133C(1):13-24
15648081
J Am Acad Child Adolesc Psychiatry. 2003 Dec;42(12):1524-9
14627890
Crisis. 2005;26(3):120-4
16276754
Am Psychol. 1999 Mar;54(3):182-203
10199218
J Affect Disord. 2008 Jan;105(1-3):25-33
17507099
Am J Psychiatry. 1999 Feb;156(2):181-9
9989552
Science. 1989 Mar 31;243(4899):1668-74
2648573
Science. 1998 May 8;280(5365):867-73
9572724
J Abnorm Psychol. 2006 Aug;115(3):616-23
16866602
Acta Psychiatr Scand. 1999 Jun;99(6):407-11
10408261
J Consult Clin Psychol. 1994 Aug;62(4):783-92
7962882
JAMA. 2005 Oct 26;294(16):2064-74
16249421
Horm Behav. 2006 Nov;50(4):504-5
16916514
Soc Psychiatry Psychiatr Epidemiol. 1990 Jul;25(4):193-9
2399476
J Abnorm Psychol. 2005 May;114(2):291-303
15869359
Arch Gen Psychiatry. 1983 Mar;40(3):249-57
6830404
Crisis. 2005;26(3):104-11
16276752
Radiology. 1982 Apr;143(1):29-36
7063747
Psychol Med. 2001 Aug;31(6):965-77
11513382
Psychiatr Serv. 2005 Jul;56(7):810-5
16020812
JAMA. 2006 Feb 15;295(7):801-8
16478903
Biometrics. 1977 Mar;33(1):159-74
843571
N Engl J Med. 1989 Nov 2;321(18):1209-14
2797086
Acta Psychiatr Scand. 1992 Feb;85(2):97-104
1543046
J Am Acad Child Adolesc Psychiatry. 1998 Sep;37(9):915-23
9735611
Ann N Y Acad Sci. 2003 Jun;989:198-210; discussion 236-46
12839899