Risk factors for the incidence and persistence of suicide-related outcomes: A 10-year follow-up study using the National Comorbidity Surveys
Open accessAbstract
Background We report prospective associations of baseline risk factors with the first onset and persistence of suicide-related outcomes (SROs; ideation, plans, gestures, and attempts) over a 10-year interval among respondents who participated in both the 1990-02 National Comorbidity Survey (NCS) and the 2000-02 National Comorbidity Survey follow-up (NCS-2).Methods A total of 5001 NCS respondents were re-interviewed (87.6% of baseline sample) in the NCS-2. Three sets of baseline (NCS) risk factors were considered as predictors of the first onset and persistence of SROs: socio-demographics, lifetime DSM-III-R disorders, and SROs.Results New onsets included 6.2% suicide ideation, 2.3% plan, 0.7% gesture, and 0.9% attempts. More than one-third of respondents with a baseline history of suicide ideation continued to have suicide ideation at some time over the intervening decade. Persistence was lower for other SROs. The strongest predictors of later SROs were baseline SROs. Prospective associations of baseline mental disorders with later SROs were largely limited to the onset and persistence of ideation.Limitations Although data were gathered prospectively, they were based on retrospective reports at both baseline and follow-up.Conclusions Baseline history of SROs explained much of the association of mental disorders with later SROs. It is important clinically to note that many of the risk factors known to predict onset of SROs also predict persistence of SROs.
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Motivations for suicidal versus non-suicidal behaviors may differ, possibly explaining why NSSI often stops in adulthood while STB may persist.
“the motivation for engaging in suicidal (e.g., intolerance of psychological pain (10); perceived burdensomeness (11)) versus non-suicidal behaviors (e.g., self-punishment (12); social signaling (13)) also may differ, perhaps influencing why NSSI often desists in adulthood (14), whereas STB may persist (15, 16).”
From Neural correlates associated with suicide and nonsuicidal self-injury in youth (2021) · cites this paper as [16]
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“Recent studies have found that although mental disorders are strongly predictive of suicidal ideation, they are less useful in predicting who with suicidal ideation will go on to have suicide attempts [15,16].”
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Comer, J. S., Puliafico, A. C., Aschenbrand, S. G., McKnight, K., Robin, J. A., Goldfine, M. E., & Albano, A. M. (2011) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2011.08.011 · Cited by 104 · see citing works
Association Between Psychotic Experiences and Subsequent Suicidal Thoughts and Behaviors
Bromet, E. J., Nock, M. K., Saha, S., Lim, C. C. W., Aguilar‐Gaxiola, S., Al-Hamzawi, A. A., Alonso, J., Borges, G. L. G., Bruffaerts, R., Degenhardt, L. J., et al. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.2647 · Cited by 101 · see citing works
Examining the role of sex in self-injurious thoughts and behaviors
Fox, K. R., Millner, A. J., Mukerji, C. E., & Nock, M. K. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.09.009 · Cited by 99 · see citing works
Suicide and cancer: Where do we go from here?
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Trajectories of suicidal ideation among adolescents following psychiatric hospitalization.
Wolff, J. C., Davis, S., Liu, R. T., Cha, C. B., Cheek, S. M., Nestor, B. A., Frazier, E. A., Schaffer, M. M., & Spirito, A. (2018) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-017-0293-6 · Cited by 95 · see citing works
“Typically, SI is not an isolated instance, and is in fact the most recurrent suicide-related outcome (Borges et al. 2008).”
BackgroundKelleher, I., Cederlöf, M., & Lichtenstein, P. (2014) · World Psychiatry · doi:10.1002/wps.20131 · Cited by 94 · see citing works
“Although most suicidal ideation is transient and does not require close clinical attention (4), for some individuals, suicidal ideation becomes persistent, causing long-term morbidity, mental distress and ultimately increasing the risk of attempted and completed suicide (5).”
BackgroundTowards understanding and predicting suicidality in women: biomarkers and clinical risk assessment
Levey, D. F., Niculescu, E. M., Le-Niculescu, H., Dainton‐Howard, H., Phalen, P. L., Ladd, T. B., Weber, H., Belanger, E. A., Graham, D. L., Khan, F., et al. (2016) · Molecular Psychiatry · doi:10.1038/mp.2016.31 · Cited by 93 · see citing works
Precision medicine for suicidality: from universality to subtypes and personalization
Niculescu, A. B., Le-Niculescu, H., Levey, D. F., Phalen, P. L., Dainton‐Howard, H., Roseberry, K., Niculescu, E. M., Niezer, J., Williams, A., Graham, D. L., et al. (2017) · Molecular Psychiatry · doi:10.1038/mp.2017.128 · Cited by 93 · see citing works
Wiebenga, J. X. M., Dickhoff, J., Mérelle, S. Y. M., Eikelenboom, M., Heering, H. D., Gilissen, R., van Oppen, P., & Penninx, B. W. J. H. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.01.053 · Cited by 91 · see citing works
Sleep disturbances and suicidal ideation in sleep medical center patients
Krakow, B. J., Ribeiro, J. D., Ulibarri, V. A., Krakow, J., & Joiner, T. E. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.12.001 · Cited by 91 · see citing works
“Research advancing our knowledge of risk factors for suicide continues to enhance our ability to predict and prevent death by suicide (Borges et al., 2008; Mann et al., 2005).”
Vander Stoep, A., Adrian, M., Mc Cauley, E., Crowell, S. E., Stone, A., & Flynn, C. (2011) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.2011.00031.x · Cited by 86 · see citing works
Gomez, S. H., Tse, J., Wang, Y., Turner, B., Millner, A. J., Nock, M. K., & Dunn, E. C. (2017) · Depression and Anxiety · doi:10.1002/da.22650 · Cited by 84 · see citing works
Self-citationKessler, R. C., Borges, G., Sampson, N., Miller, M., & Nock, M. K. (2009) · Molecular Psychiatry · doi:10.1038/mp.2008.78 · Cited by 81 · see citing works
Self-citationDiscrimination and suicidality among racial and ethnic minorities in the United States
Oh, H. Y., Stickley, A., Koyanagi, A., Yau, R. K., & DeVylder, J. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.11.059 · Cited by 84 · see citing works
Mojtabai, R., Stuart, E. A., Hwang, I. H., Eaton, W. W., Sampson, N. A., & Kessler, R. C. (2017) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-017-1373-1 · Cited by 79 · see citing works
“The second wave was the 2001–2003 NCS follow-up survey (NCS-2) [26].”
Cognitive reactivity: Investigation of a potentially treatable marker of suicide risk in depression
Antypa, N., van der Does, W. A. J., & Penninx, B. W. J. H. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.06.013 · Cited by 78 · see citing works
“The known risk factors for suicide attempt and ideation (Bernal et al., 2007; Borges et al., 2008;Kessleret al.,1999;Nocket al., 2008;Oquendoet al., 2006; Sokero et al., 2003) mostly refer to demographic and clinical characteristics which are informative in identifying groups at risk but…”
BackgroundBagge, C. L., Littlefield, A. K., Conner, K. R., Schumacher, J. A., & Lee, H. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.04.010 · Cited by 76 · see citing works
Guan, L., Hao, B., Cheng, Q., YIP, P. S. F., & Zhu, T. (2015) · JMIR Mental Health · doi:10.2196/mental.4227 · Cited by 76 · see citing works
“Although many risk factors have been reported to be correlated with suicide probability, it is still difficult to identify suicidal individuals, since suicidal behavior consists of a constellation of complex factors and everyone is unique [10-12].”
Suicidality, ethnicity and immigration in the USA
Borges, G. L. G., Orozco, R., Rafful, C. M., Miller, E. P., & Breslau, J. A. (2011) · Psychological Medicine · doi:10.1017/s0033291711002340 · Cited by 76 · see citing works
“…surveys of adults in the USA have reported lower prevalence of attempts only among Blacks, relative to Non-Hispanic Whites (Kessler et al. 1999 ; Borges et al. 2006, 2008), but no studies have focused systematically on possible differences across the main ethnic groups in the USA using…”
BackgroundInfluentialBoxer, P. (2010) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2010.486302 · Cited by 71 · see citing works
Kuramoto, S. J., Chilcoat, H. D., Ko, J. Y., & Martins, S. S. (2012) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2012.73.178 · Cited by 70 · see citing works
“Furthermore, our fi ndings are generally consistent with previous fi ndings that suggest that those who use drugs illegally and meet the criteria for drug use disorders are at increased risk for suicidal ideation but not attempt among those who report ideation (Borges et al., 2008).”
ResultMental disorders and risk of suicide attempt in prisoners
Favril, L., Indig, D., Gear, C., & Wilhelm, K. (2020) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-020-01851-7 · Cited by 69 · see citing works
Allen, M. H., Abar, B. W., McCormick, M., Barnes, D. H., Haukoos, J. S., Garmel, G. M., & Boudreaux, E. D. (2013) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12018 · Cited by 68 · see citing works
Rogers, M. L., Chiurliza, B., Hagan, C. R., Tzoneva, M., Hames, J. L., Michaels, M. S., Hitschfeld, M. J., Palmer, B. A., Lineberry, T. W., Jobes, D. A., et al. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.12.057 · Cited by 68 · see citing works
“As prevalence rates of suicidal ideation are many times higher than rates of suicide attempts (Borges et al., 2012, 2008; Kessler et al., 1999), and suicidal ideation alone is a poor predictor of suicidal behavior (Borges et al., 2008; Fowler, 2012), the widespread use of suicidal ideation as an…”
BackgroundAdolescent suicidal behavior across the excess weight status spectrum
Zeller, M. H., Reiter‐Purtill, J., Jenkins, T. M., & Ratcliff, M. B. (2013) · Obesity · doi:10.1002/oby.20084 · Cited by 67 · see citing works
“Only a history of progression to an attempt is associated with subsequent risk of a nonfatal or fatal suicide attempt in adolescents (3,29).”
BackgroundBruwer, B. R., Govender, R., Bishop, M., Williams, D. R., Stein, D. J., & Seedat, S. (2014) · BMJ Open · doi:10.1136/bmjopen-2013-004644 · Cited by 67 · see citing works
“Notwithstanding these limitations, this study represents the fi rst investigation among South Africans of a wide range of childhood adversities and their impact on the onset and persistence of suicidality over the life course.”
ten Have, M., van Dorsselaer, S., & de Graaf, R. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.11.005 · Cited by 63 · see citing works
Remission of suicidal thoughts: Findings from a longitudinal epidemiological study
Teismann, T., Forkmann, T., Glaesmer, H., Egeri, L., & Margraf, J. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.09.066 · Cited by 63 · see citing works
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Psychological factors associated with the incidence and persistence of suicidal ideation
Zhang, Y., Law, C. K., & Yip, P. S. F. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.05.003 · Cited by 59 · see citing works
“Rather than becoming entangled in this debate, we prefer to clarify that the criteria for persistence in this study were identified in accordance with Borges et al. (2008) and refer to ideators at both baseline (lifetime ideation) and follow-up (past 12-month ideation).”
BackgroundMethodResultInfluentialRogers, M. L., Ringer, F. B., & Joiner, T. E. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.09.061 · Cited by 58 · see citing works
Reducing suicidal ideation through evidence-based treatment for posttraumatic stress disorder
Cox, K. S., Mouilso, E. R., Venners, M. R., Defever, M. E., Duvivier, L., Rauch, S. A. M., Strom, T. Q., Joiner, T. E., & Tuerk, P. W. (2016) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2016.05.011 · Cited by 57 · see citing works
School and Community Violence and Victimization as Predictors of Adolescent Suicidal Behavior
Nickerson, A. B., & Slater, E. D. (2009) · School Psychology Review · doi:10.1080/02796015.2009.12087803 · Cited by 57 · see citing works
Bennardi, M., Caballero, F. F., Miret, M., Ayuso‐Mateos, J. L., Haro, J. M., Lara, E., Arensman, E., & Cabello, M. (2019) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12424 · Cited by 54 · see citing works
Suicidal risk and childhood adversity: A study of Indian college students
Singh, S., Manjula, M., & Philip, M. (2012) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2012.02.024 · Cited by 56 · see citing works
Using Implicit and Explicit Measures to Predict Nonsuicidal Self-Injury Among Adolescent Inpatients.
Cha, C. B., Augenstein, T. M., Frost, K., Gallagher, K., D'Angelo, E., & Nock, M. (2016) · Journal of the American Academy of Child and Adolescent Psychiatry · doi:10.1016/j.jaac.2015.10.008 · Cited by 49 · see citing works
The androgen model of suicide completion
Lenz, B., Röther, M., Bouna-Pyrrou, P., Mühle, C., Tektas, O. Y., & Kornhuber, J. (2018) · Progress in Neurobiology · doi:10.1016/j.pneurobio.2018.06.003 · Cited by 56 · see citing works
“When looking more closely, it appears that most of the previously identified risk factors, such as major depressive disorder, predict significantly ideation but not or more weakly attempts among individuals considering suicide (Borges et al., 2008; Nock et al., 2010).”
Positive Mental Health, Stressful Life Events, and Suicide Ideation.
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Contributors to suicidality in rural communities: beyond the effects of depression
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“Prior suicidal ideation or suicide attempts are the primary risk factors for future suicidal behaviours [1,2].”
BackgroundLongitudinal course of suicidal ideation and predictors of its persistence – A NESDA study
Kivelä, L. M. M., Krause-Utz, A., Mouthaan, J., Schoorl, M., de Kleine, R. A., Elzinga, B. M., Eikelenboom, M., Penninx, B. W. J. H., van der Does, W. A. J., & Antypa, N. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.07.042 · Cited by 53 · see citing works
“, 2009) and more than a third reported persistent suicidal ideation over ten years (Borges et al., 2008).”
BackgroundSilva, C., Chu, C., Monahan, K. R., & Joiner, T. E. (2014) · Psychology of Sexual Orientation and Gender Diversity · doi:10.1037/sgd0000086 · Cited by 56 · see citing works
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Association of solitary binge drinking and suicidal behavior among emerging adult college students.
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“[9,33] Furthermore, the medical condition of the patient, which is associated with suicide in patients with cancer, was not associated with suicidal ideation or suicide attempts in FCs.”
BackgroundA Risk Algorithm for the Persistence of Suicidal Thoughts and Behaviors During College
Mortier, P., Kiekens, G., Auerbach, R. P., Cuijpers, P. J., Demyttenaere, K., Green, J. G., Kessler, R. C., Nock, M. K., Zaslavsky, A. M., & Bruffaerts, R. (2017) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.17m11485 · Cited by 48 · see citing works
Testing mood-activated psychological markers for suicidal ideation
Cha, C. B., O'Connor, R. C., Kirtley, O., Cleare, S., Wetherall, K., Eschle, S., Tezanos, K. M., & Nock, M. K. (2018) · Journal of Abnormal Psychology · doi:10.1037/abn0000358 · Cited by 47 · see citing works
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“…National Comorbidity Survey revealed that the association of suicidal ideation at the initial survey with suicide-related outcomes (suicidal ideation, plans, gestures, and attempts) 10 years later is overwhelmed by the influence of suicidal ideation measured more proximally (Borges et al., 2008).”
BackgroundAnxiety disorders and risk for suicide: why such controversy?
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A proposed model of the development of suicidal ideations
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- Authors
- Borges, G., Angst, J., Nock, M. K., Ruscio, A. M., & Kessler, R. C.
- Affiliations
- Universidad Autónoma Metropolitana (MX)
- University Hospital Zurich (CH)
- Harvard University (US)
- Corresponding author
- Kessler, Ronald C.
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2008-01
- Volume
- 105
- Issue
- 1-3
- Pages
- 25-33
- ISSN
- 0165-0327 (ISSN-L)
- PMC
- PMC2248274
- OpenAlex
- W2136828172
- Cited by
- 334
- References
- 46
- Citations by year
- 2026: 7 · 2025: 12 · 2024: 10 · 2023: 16 · 2022: 20 · 2021: 21 · 2020: 16 · 2019: 24 · 2018: 17 · 2017: 23 · 2016: 24 · 2015: 21 · 2014: 37 · 2013: 13 · 2012: 25
- FWCI
- 10.75
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- Substance Abuse and Mental Health Services Administration
- Robert Wood Johnson Foundation (044780)
- National Institute of Mental Health (U01-MH60220)
- John W. Alden Trust
- National Institute on Drug Abuse (DA12058)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- suicidal ideation, suicide planning, suicide attempts, risk factors, mental illness, lifetime psychiatric disorders, National Comorbidity Survey, prospective follow-up
- MeSH terms
- Adolescent, Adult, Mental Disorders, Demography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Risk Factors, Suicide, Suicide, Attempted, Time Factors, United States, Comorbidity, Incidence, Prevalence
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