The British Journal of Psychiatry (2008) 192: 98-105. doi: 10.1192/bjp.bp.107.040113
© 2008 The Royal College of Psychiatrists
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Cross-national prevalence and risk factors for suicidal ideation, plans and attempts

Matthew K. Nock, PhD

Department of Psychology, Harvard University, Massachusetts, USA

Guilherme Borges, PhD

Department of Epidemiology, National Institute of Psychiatry and Universidad Autonoma Metropolitana, Mexico City, Mexico

Evelyn J. Bromet, PhD

Department of Psychiatry, State University of New York, Stony Brook, USA

Jordi Alonso, MD, PhD

Health Services Research Unit, Institut Municipal d'Investigacio Medica IMIM, Barcelona, Spain

Matthias Angermeyer, MD

University of Leipzig, Department of Psychiatry, Leipzig, Germany

Annette Beautrais, PhD

Christchurch School of Medicine & Health Sciences, New Zealand

Ronny Bruffaerts, PhD

Department of Neurosciences and Psychiatry, University Hospitals, Gasthuisberg, Belgium

Wai Tat Chiu, AM

Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA

Giovanni de Girolamo, MD

Department of Mental Health, AUSL di Bologna, Bologna, Italy

Semyon Gluzman, MD

Ukrainian Psychiatric Association, Kyiv, Ukraine

Ron de Graaf, PhD

Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands

Oye Gureje, MD, PhD, FRCPsych

Department of Psychiatry, University College Hospital, Ibadan, Nigeria

Josep Maria Haro, MD, MPH, PhD

Sant Joan de Deu-SSM, Barcelona, Spain

Yueqin Huang, MPH, MD, PhD

Institute of Mental Health, Peking University, People's Republic of China

Elie Karam, MD

Department of Psychiatry and Psychology, St George Hospital University Medical Center, Beirut, Lebanon

Ronald C. Kessler, PhD

Department of Psychology, Harvard University, Massachusetts, USA

Jean Pierre Lepine, MD

Hospital Fernand Widal, Paris, France

Daphna Levinson, PhD

Research and Planning, Mental Health Services, Ministry of Health, Jerusalem, Israel

Maria Elena Medina-Mora, PhD

Department of Epidemiology, National Institute of Psychiatry and Universidad Autonoma Metropolitana, Mexico City, Mexico

Yutaka Ono, MD

Keio University, Tokyo, Japan

José Posada-Villa, MD

Colegio Mayor de Cundinamarca University, Saldarriaga Concha Foundation, Bogota, Colombia

David Williams, PhD, MPH

Harvard University School of Public Health, Boston, Massachusetts, USA.

Correspondence: Matthew K. Nock, PhD, Department of Psychology, Harvard University, 33 Kirkland Street, 1280 Cambridge, MA 02138, USA. Email: nock{at}wjh.harvard.edu

Declaration of interests

None. Funding detailed in Acknowledgements.

Background

Suicide is a leading cause of death worldwide; however, the prevalence and risk factors for the immediate precursors to suicide – suicidal ideation, plans and attempts – are not wellknown, especially in low- and middle-income countries.

Aims

To report on the prevalence and risk factors for suicidal behaviours across 17 countries.

Method

A total of 84 850 adults were interviewed regarding suicidal behaviours and socio-demographic and psychiatric risk factors.

Results

The cross-national lifetime prevalence of suicidal ideation, plans, and attempts is 9.2% (s.e.=0.1), 3.1% (s.e.=0.1), and 2.7% (s.e.=0.1). Across all countries, 60% of transitions from ideation to plan and attempt occur within the first year after ideation onset. Consistent cross-national risk factors included being female, younger, less educated, unmarried and having a mental disorder. Interestingly, the strongest diagnostic risk factors were mood disorders in high-income countries but impulse control disorders in low- and middle-income countries.

Conclusion

There is cross-national variability in the prevalence of suicidal behaviours, but strong consistency in the characteristics and risk factors for these behaviours. These findings have significant implications for the prediction and prevention of suicidal behaviours.


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