Cross-National Analysis of the Associations between Traumatic Events and Suicidal Behavior: Findings from the WHO World Mental Health Surveys

Author(s):Show less -

Stein, Dan J. ^[1] ; Chiu, Wai Tat ^[2] ; Hwang, Irving ^[2] ; Kessler, Ronald C. ^[2] ; Sampson, Nancy ^[2] ; Alonso, Jordi ^[3] ; Borges, Guilherme ^{[4, 5]} ; Bromet, Evelyn ^[6] ; Bruffaerts, Ronny ^[7] ; de Girolamo, Giovanni ^[8] ; Florescu, Silvia ^[9] ; Gureje, Oye ^[10] ; He, Yanling ^[11] ; Kovess-Masfety, Viviane ^[12] ; Levinson, Daphna ^[13] ; Matschinger, Herbert ^[14] ; Mneimneh, Zeina ^{[15, 16]} ; Nakamura, Yosikazu ; Ormel, Johan ^[17] ; Posada-Villa, Jose ^[18] ; Sagar, Rajesh ^[19] ; Scott, Kate M. ^[20] ; Tomov, Toma ^[21] ; Viana, Maria Carmen ^[22] ; Williams, David R. ^[23] ; Nock, Matthew K. ^[24]

Affiliation:Show less -

^[1] Groote Schuur Hosp, Dept Psychiat, ZA-7925 Cape Town - South Africa

^[2] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 - USA

^[3] CIBERESP, Hlth Serv Res Unit, Inst Municipal Invest Med, Hosp del Mar, Barcelona - Spain

^[4] Natl Inst Psychiat Mexico, Dept Epidemiol Res, Div Epidemiol & Psychosocial Res, Mexico City, DF - Mexico

^[5] Metropolitan Autonomous Univ, Mexico City, DF - Mexico

^[6] SUNY Stony Brook, Dept Psychiat, Stony Brook, NY 11794 - USA

^[7] Univ Hosp Gasthuisberg, B-3000 Louvain - Belgium

^[8] IRCCS, Ctr San Giovanni Dio Fatebenefratelli, Brescia - Italy

^[9] Natl Sch Publ Hlth & Hlth Serv Management, Bucharest - Romania

^[10] Univ Coll Ibadan Hosp, Ibadan - Nigeria

^[11] Shanghai Mental Hlth Ctr, Shanghai - Peoples R China

^[12] Univ Paris 05, EA 4069, Paris - France

^[13] Minist Hlth, Mental Hlth Serv, Jerusalem - Israel

^[14] Univ Leipzig, Psychiat Clin, Leipzig - Germany

^[15] IDRAAC, Beirut - Lebanon

^[16] Univ Michigan, Inst Social Res, Survey Res Ctr, Ann Arbor, MI - USA

^[17] Univ Groningen, Univ Med Ctr Groningen, Univ Ctr Psychiat, Dept Psychiat & Psychiat Epidemiol, NL-9713 AV Groningen - Netherlands

^[18] Univ Javerina, Ctr Med Sabana, Bogota - Colombia

^[19] All India Inst Med Sci, Dept Psychiat, Delhi - India

^[20] Wellington Sch Med & Hlth Sci, Dept Psychol Med, Otago - New Zealand

^[21] New Bulgarian Univ, Inst Human Relat, Sofia - Bulgaria

^[22] Univ Sao Paulo, Dept Psychiat Epidemiol, Inst Psychiat, Sao Paulo - Brazil

^[23] Harvard Univ, Sch Publ Hlth, Dept Soc Human Dev & Hlth, Boston, MA 02115 - USA

^[24] Harvard Univ, Dept Psychol, Cambridge, MA 02138 - USA

• Document type: Journal article
• Source: PLoS One; v. 5, n. 5, p. e10574, 2010.
• Web of Science Citations: 130

Abstract

Background: Community and clinical data have suggested there is an association between trauma exposure and suicidal behavior (i.e., suicide ideation, plans and attempts). However, few studies have assessed which traumas are uniquely predictive of: the first onset of suicidal behavior, the progression from suicide ideation to plans and attempts, or the persistence of each form of suicidal behavior over time. Moreover, few data are available on such associations in developing countries. The current study addresses each of these issues. Methodology/Principal Findings: Data on trauma exposure and subsequent first onset of suicidal behavior were collected via structured interviews conducted in the households of 102,245 (age 18+) respondents from 21 countries participating in the WHO World Mental Health Surveys. Bivariate and multivariate survival models tested the relationship between the type and number of traumatic events and subsequent suicidal behavior. A range of traumatic events are associated with suicidal behavior, with sexual and interpersonal violence consistently showing the strongest effects. There is a dose-response relationship between the number of traumatic events and suicide ideation/attempt; however, there is decay in the strength of the association with more events. Although a range of traumatic events are associated with the onset of suicide ideation, fewer events predict which people with suicide ideation progress to suicide plan and attempt, or the persistence of suicidal behavior over time. Associations generally are consistent across high-, middle-, and low-income countries. Conclusions/Significance: This study provides more detailed information than previously available on the relationship between traumatic events and suicidal behavior and indicates that this association is fairly consistent across developed and developing countries. These data reinforce the importance of psychological trauma as a major public health problem, and highlight the significance of screening for the presence and accumulation of traumatic exposures as a risk factor for suicide ideation and attempt. (AU)

• FAPESP's process: 03/00204-3 - Epidemiological study of psychiatric disorders in the São Paulo Metropolitan Region: prevalence, risk factors, and social and economical burden
• Grantee: Laura Helena Silveira Guerra de Andrade
• Support Opportunities: Research Projects - Thematic Grants