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. Method: 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 socio-demographic 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. J Clin Psychiatry 2010;71(12):1617-1628 (C) Copyright 2010 Physicians Postgraduate Press, Inc.

Bristol-Myers Squibb

Eli Lilly

GlaxoSmithKline

Johnson Johnson

Ortho-McNeil

Pfizer

sanofi-aventis

US National Institute of Mental Health (NIMH/NIH)[R01MH070884]

US National Institute of Mental Health (NIMH/NIH)[R01MH077883]

John D. and Catherine T. MacArthur Foundation

Pfizer Foundation

US Public Health Service[R13-MH066849]

US Public Health Service[R01-MH069864]

US Public Health Service[R01 DA016558]

Fogarty International Center (FIRCA/NIH)[FIRCA R03-TW006481]

Pan American Health Organization (PAHO)

FAPESP State of Sao Paulo Research Foundation[03/00204-3]

Shenzhen Bureau of Health and the Shenzhen Bureau of Science, Technology, and Information

Ministry of Social Protection

European Commission[QLG5-1999-01042]

European Commission[SANCO 2004123]

Piedmont Region (Italy)

Fondo de Investigacion Sanitaria, Institut de Salud Carlos III, Spain[FIS 00/0028]

Ministerio de Ciencia y Tecnologia, Spain[SAF 2000-158-CE]

Departament de Salut

Generalitat de Catalunya, Spain

Institut de Salud Carlos III[CIBER CB06/02/0046]

Institut de Salud Carlos III[RETICS RD06/0011 REM-TAP]

WHO (India)

Ministry of Health

Israel National Institute for Health Policy and Health Services Research

National Insurance Institute of Israel

Japan Ministry of Health, Labour and Welfare[H13-SHOGAI-023]

Japan Ministry of Health, Labour and Welfare[H14-TOKUBETSU-026]

Japan Ministry of Health, Labour and Welfare[H16-KOKOR0-013]

Lebanese Ministry of Public Health

WHO (Lebanon)

Fogarty International (FIRCA/NIH)

Act for Lebanon

Janssen Cilag

Roche

Novartis

National Institute of Psychiatry Ramon de la Fuente[INPRFMDIES 4280]

National Council on Science and Technology[CONACyT-G30544-H]

New Zealand Ministry of Health

Alcohol Advisory Council

Health Research Council

WHO (Geneva)

WHO (Nigeria)

Federal Ministry of Health, Abuja, Nigeria

Ministry of Public Health

US National Institute of Mental Health (NIMH/NIH)[R01-MH059575]

US National Institute of Mental Health (NIMH/NIH)[R01-MH61905]

US National Institute of Mental Health (NIMH/NIH)[U01-MH60220]

National Institute of Drug Abuse (NIDA/NIH)

South African Department of Health

University of Michigan

Substance Abuse and Mental Health Services Administration

Robert Wood Johnson Foundation[044708]

John W. Alden Trust