title: War and first onset of suicidality: the role of mental disorders.
abstract: BACKGROUND
  Suicide rates increase following periods of war; however, the mechanism through which this occurs is not known. The aim of this paper is to shed some light on the associations of war exposure, mental disorders, and subsequent suicidal behavior.
  
  
  METHODS
  A national sample of Lebanese adults was administered the Composite International Diagnostic Interview to collect data on lifetime prevalence and age of onset of suicide ideation, plan, and attempt, and mental disorders, in addition to information about exposure to stressors associated with the 1975-1989 Lebanon war.
  
  
  RESULTS
  The onset of suicide ideation, plan, and attempt was associated with female gender, younger age, post-war period, major depression, impulse-control disorders, and social phobia. The effect of post-war period on each type of suicide outcome was largely explained by the post-war onset of mental disorders. Finally, the conjunction of having a prior impulse-control disorder and either being a civilian in a terror region or witnessing war-related stressors was associated with especially high risk of suicide attempt.
  
  
  CONCLUSIONS
  The association of war with increased risk of suicidality appears to be partially explained by the emergence of mental disorders in the context of war. Exposure to war may exacerbate disinhibition among those who have prior impulse-control disorders, thus magnifying the association of mental disorders with suicidality.
authors.affiliation: Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon. idraac@idraac.org
authors.forename: E G
authors.initials: EG
authors.lastname: Karam
authors.forename: M M
authors.initials: MM
authors.lastname: Salamoun
authors.forename: Z N
authors.initials: ZN
authors.lastname: Mneimneh
authors.forename: J A
authors.initials: JA
authors.lastname: Fayyad
authors.forename: A N
authors.initials: AN
authors.lastname: Karam
authors.forename: R
authors.initials: R
authors.lastname: Hajjar
authors.forename: H
authors.initials: H
authors.lastname: Dimassi
authors.forename: M K
authors.initials: MK
authors.lastname: Nock
authors.forename: R C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D000368:Aged; D005260:Female; D006306:Health Surveys / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007406:Interview, Psychological / Q000379:methods; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology*; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D014857:Warfare; D055815:Young Adult