title: Mental disorders and risk of suicide attempt: a national prospective study.
abstract: Most mental disorders, when examined independently, are associated with an elevated risk for suicide attempt. However, mental disorders often co-occur, and that co-occurrence is well explained by models where specific mental disorders are understood as manifestations of latent dimensions of psychopathology. To date, it remains unclear whether the risk of suicide attempt is due to specific mental disorders, to specific dimensions of psychopathology (that is, internalizing and externalizing dimensions), to a general psychopathology factor or to a combination of these explanations. In a large nationally representative prospective survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we used structural equation modeling to examine the shared and specific effects of Axis I and Axis II disorders on the occurrence of suicide attempts in the general population and among individuals with a lifetime history of suicidal ideation. Effects of mental disorders on the risk of suicide attempt were exerted almost exclusively through a general psychopathology factor representing the shared effect across all mental disorders. Effects of remitted psychiatric disorders on the risk of suicide attempt were fully mediated by current mental disorders. Similar patterns of associations were found in individuals with suicidal ideation. These results held when using different approaches to modeling psychiatric comorbidity. Our findings underscore the importance of adopting dimensional approaches to comorbidity in the study of suicidal behavior. Because mental disorders increase the risk of suicide attempt through a general psychopathology liability, this dimension should be considered as an important therapeutic target to substantially advance suicide prevention.
authors.affiliation: 1] Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA [2] Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France [3] INSERM UMR 894, Psychiatry and Neurosciences Center, Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Hoertel
authors.affiliation: Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Franco
authors.affiliation: 1] Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA [2] Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Wall
authors.affiliation: Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Oquendo
authors.affiliation: 1] Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA [2] Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: B T
authors.initials: BT
authors.lastname: Kerridge
authors.affiliation: 1] Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France [2] INSERM UMR 894, Psychiatry and Neurosciences Center, Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Limosin
authors.affiliation: Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
authors.forename: C
authors.initials: C
authors.lastname: Blanco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult