Multiple disorders predictive of suicide

While a wide range of mental disorders increase the odds of experiencing suicide ideation only disorders characterised by anxiety and poor impulse control predict which people will act on those thoughts, an analysis of the WHO World Mental Health Surveys finds. Clinically, the results demonstrated the importance of considering not only depression but also the full range of mental disorders when evaluating patients’ risk for suicidal behaviour, the study author’s said. The multi-national study examined the prevalence of 16 mental health disorders, using face-to-face interviews with over 100, 000 participants in 21 developed and developing countries. While the study found that a “sizeable minority” of respondents report suicidal behaviours in the absence of any mental disorder, it also found that each lifetime mental health disorder significantly predicted the subsequent first onset of suicide attempt (ORs of 2.9–8.9). After controlling for comorbidity the associations decreased substantially but remained significant in most cases, although the risk of suicide decreased as the number of disorders increased. Importantly, a population attributable risk proportion analysis showed that the predictive effects of mental disorders on suicide attempts were largely due to effects on ideation rather than on the transitions from ideation to plans or attempts. In fact, the authors noted that while depression was strongly predictive of suicide in their study, “decomposition of this association revealed that it is due largely to depression predicting the onset of suicide ideation”. The study also found that while the strongest predictors of suicide attempts in developed countries were mood disorders, in developing countries impulse-control, substance use, and post-traumatic stress disorders were most predictive. “Given the especially strong association between multi-morbidity and suicidal behaviour, clinicians should always conduct a suicide risk assessment among patients presenting with multiple disorders,” they concluded. PLoS Med 6(8): e1000123....