TY - JOUR
T1 - Cross-national analysis of the associations between traumatic events and suicidal behavior
T2 - Findings from the who world mental health surveys
AU - Stein, Dan J.
AU - Chiu, Wai Tat
AU - Hwang, Irving
AU - Kessler, Ronald C.
AU - Sampson, Nancy
AU - Alonso, Jordi
AU - Borges, Guilherme
AU - Bromet, Evelyn
AU - Bruffaerts, Ronny
AU - de Girolamo, Giovanni
AU - Florescu, Silvia
AU - Gureje, Oye
AU - He, Yanling
AU - Kovess-Masfety, Viviane
AU - Levinson, Daphna
AU - Matschinger, Herbert
AU - Mneimneh, Zeina
AU - Nakamura, Yosikazu
AU - Ormel, Johan
AU - Posada-Villa, Jose
AU - Sagar, Rajesh
AU - Scott, Kate M.
AU - Tomov, Toma
AU - Viana, Maria Carmen
AU - Williams, David R.
AU - Nock, Matthew K.
PY - 2010
Y1 - 2010
N2 - 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.
AB - 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.
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U2 - 10.1371/journal.pone.0010574
DO - 10.1371/journal.pone.0010574
M3 - Article
C2 - 20485530
AN - SCOPUS:77956295897
VL - 5
JO - PLoS One
JF - PLoS One
SN - 1932-6203
IS - 5
M1 - e10574
ER -