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Cited by 1,125Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseMental Health Treatment and Access

Mental disorders, comorbidity and suicidal behavior: Results from the National Comorbidity Survey Replication

Open access
Nock, M K, Hwang, I, Sampson, N A, Kessler, R C·2010·Molecular Psychiatry
DOI 10.1038/mp.2009.29PMC PMC2889009
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Abstract

Mental disorders are among the strongest predictors of suicide attempts. However, little is known regarding which disorders that are uniquely associated with suicidal behavior because of high levels of psychiatric comorbidity. We examined the unique associations between individual disorders and subsequent suicidal behavior (suicide ideation, plans and attempts) using data from the National Comorbidity Survey Replication, a nationally representative household survey of 9282 US adults. Results revealed that approximately 80% of suicide attempters in the United States have a temporally prior mental disorder. Anxiety, mood, impulse-control and substance use disorders all significantly predict subsequent suicide attempts in bivariate analyses (odds ratios (OR)=2.7-6.7); however, these associations decrease substantially in multivariate analyses controlling for comorbidity (OR=1.5-2.3) but remain statistically significant in most cases. Disaggregation of the observed effects reveals that depression predicts suicide ideation, but not suicide plans or attempts among those with ideation. Instead, disorders characterized by severe anxiety/agitation (for example, post-traumatic stress disorder) and poor impulse control (for example, conduct disorder, substance use disorders) predict which suicide ideators who go on to make a plan or attempt. These results advance understanding of the unique associations between mental disorders and different forms of suicidal behavior. Future research must further delineate the mechanisms through which people come to think about suicide and progress from suicidal thoughts to attempts.

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Crossref · 10.1038/mp.2009.29

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  • Ideation-to-action theories focus on suicide capability, which determines the transition from suicidal ideation to suicidal behavior.

    “Rather than emphasizing the role of suicide risk factors, it focuses on the concept of suicide “capability”, which determines the transition from suicidal ideation to (lethal and non-lethal) suicidal behavior.”

    From Psychiatric euthanasia, suicide and the role of gender (2022) · cites this paper as [19]

    The Discussion (page unavailable) distinguishes factors associated with suicidal ideation from those associated with acting on suicidal thoughts. It does not describe ideation-to-action theories, identify suicide “capability” as the determining concept, or establish a transition to both lethal and non-lethal behavior. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Individuals living with MDD have reported a significant increase in other mental health disorders including anxiety, alcohol and drug use, and suicidal ideation/attempts.

    “Individuals living with MDD have reported a significant increase in other mental health disorders including anxiety [59], alcohol and drug use [60], and suicidal ideation/attempts [61].”

    From The Cyclical Battle of Insomnia and Mental Health Impairment in Firefighters: A Narrative Review (2024) · cites this paper as [61]

  • Suicide capability includes practical factors such as knowledge of and access to highly lethal means and psychological factors such as fearlessness of death and pain tolerance, all of which can be acquired over time.

    “Within this framework, “capability” includes practical factors (knowledge of and access to highly lethal means) and psychological factors (fearlessness of death, pain tolerance), both of which can be acquired over time.(14–19)”

    From Psychiatric euthanasia, suicide and the role of gender (2022) · cites this paper as [19]

    The Methods section (page unavailable) measures suicidal ideation, plans, and attempts, while the Discussion (page unavailable) addresses mental disorders and progression to attempts. Searches for fearlessness of death, pain tolerance, lethal means, and acquired capability found no passage in our copy defining capability or saying these factors can be acquired over time. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

  • The psychological components of suicide capability include the ability to face death and to enact something painful to one's own body.

    “The important psychological components of capability involve the ability to face death and to enact something painful to one’s own body. (16, 19)”

    From Psychiatric euthanasia, suicide and the role of gender (2022) · cites this paper as [19]

    The Discussion distinguishes suicidal ideation from acting on suicidal thoughts, but does not describe an ability to face death or inflict pain on one’s own body. Searches for those components and for fear of death and pain tolerance found no passage addressing the claimed components of suicide capability. No page numbers were available in our copy. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

  • Comorbid anxiety and/or substance use disorders are found among most people diagnosed with depression, both in community epidemiological surveys and in studies of primary care or specialized care settings.

    “Comorbid anxiety and/or substance use disorders are found among most people diagnosed with depression, both in community epidemiological surveys 174 and in studies of primary care 175 or specialized care settings. 176”

    From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [175]

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Research works printed but not linked: 2

  1. [29]First MB Spitzer RL Gibbon M Williams JBW Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-Patient Edition (SCID-I/NP) 2002 Biometrics Research, New York State Psychiatric Institute New York, NY
  2. [36]Schlesselman JJ Case-control studies: Design, conduct, and analysis 1982 Oxford University Press New York, NY

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Authors
Nock, M. K., Hwang, I., Sampson, N. A., & Kessler, R. C.
Affiliations
Harvard University (US)
Corresponding author
Nock, M K
ORCID
Venue
Molecular Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2009-03-31
Volume
15
Issue
8
Pages
868-876
ISSN
  • 1359-4184 (ISSN-L)
  • 1476-5578
DOI
10.1038/mp.2009.29
PMC
PMC2889009
OpenAlex
W2142470720
Cited by
1,125
References
46
Citations by year
2026: 51 · 2025: 62 · 2024: 76 · 2023: 62 · 2022: 81 · 2021: 91 · 2020: 79 · 2019: 85 · 2018: 99 · 2017: 79 · 2016: 70 · 2015: 72 · 2014: 58 · 2013: 56 · 2012: 45
FWCI
36.72
Type
journal article
Language
en
Open access
Licence
Locations
  • Molecular Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
  • National Institutes of Health (5r01mh069864-04, 5r01mh070884-05)
  • National Institute of Mental Health (R01‐MH070884, R01MH077883, U01-MH-60220, U13MH066849, U01MH060220, MH077883, R01‐MH069864)
  • National Institute on Drug Abuse (K05DA015799, R01DA016558)
  • Fogarty International Center (R03TW006481)
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 behavior, suicide attempts, suicidal ideation, suicide planning, psychiatric comorbidity, mental illness, depression, anxiety disorders, post-traumatic stress disorder, impulse control disorders, conduct disorder, substance use disorders, mood disorders, National Comorbidity Survey Replication
MeSH terms
Mental Disorders, Female, Health Surveys, Humans, Male, Suicide, United States, Comorbidity, Prevalence, Multivariate Analysis, Mood Disorders, Diagnostic and Statistical Manual of Mental Disorders

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