Research Article: Cross-National Analysis of the Associations among Mental Disorders and Suicidal Behavior: Findings from the WHO World Mental Health Surveys

Date Published: August 11, 2009

Publisher: Public Library of Science

Author(s): Matthew K. Nock, Irving Hwang, Nancy Sampson, Ronald C. Kessler, Matthias Angermeyer, Annette Beautrais, Guilherme Borges, Evelyn Bromet, Ronny Bruffaerts, Giovanni de Girolamo, Ron de Graaf, Silvia Florescu, Oye Gureje, Josep Maria Haro, Chiyi Hu, Yueqin Huang, Elie G. Karam, Norito Kawakami, Viviane Kovess, Daphna Levinson, Jose Posada-Villa, Rajesh Sagar, Toma Tomov, Maria Carmen Viana, David R. Williams, Rachel Jenkins

Abstract: Using data from over 100,000 individuals in 21 countries participating in the WHO World Mental Health Surveys, Matthew Nock and colleagues investigate which mental health disorders increase the odds of experiencing suicidal thoughts and actual suicide attempts, and how these relationships differ across developed and developing countries.

Partial Text: Suicide is among the leading causes of death and disease burden around the world [1]–[4]. Although there have been significant advances in suicide research as well as increases in the treatment of suicidal people, the rate of suicidal behaviors has not changed as a result [1],[5]. The seriousness of this problem has led the World Health Organization (WHO) [6], the U.S. Surgeon General [7], the U.S. Department of Health and Human Services [8], and the Institute of Medicine [2] to call for research aimed at better understanding the risk factors for suicide and nonfatal suicidal behavior. Nonfatal suicidal behaviors are important because they are among the most powerful predictors of subsequent suicide deaths [9]–[12] and because they are significant outcomes in their own right that cause substantial distress.

Several noteworthy findings were revealed in this study. The finding that approximately half of those who seriously consider killing themselves, and more than half of those making a suicide attempt have a prior mental disorder extends earlier findings from psychological autopsy studies [43] and studies using clinical samples [24],[44] that have reported that most suicide attempters have a diagnosable mental disorder. Notably, the rates of mental disorder in the current study—even among suicide attempters—were much lower than those documented in prior studies among clinical samples and those dying by suicide, which suggests that the rate of mental disorders among suicidal people in the general population is lower than in these other groups. Moreover, we examined lifetime mental disorders, whereas studies of suicide decedents and clinical samples assess current or recent disorders, making the differences between clinical and general population studies even more pronounced.