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Mental disorders, comorbidity and suicidal behavior: Results from the National Comorbidity Survey Replication
Open accessAbstract
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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“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]
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“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]
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“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]
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“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]
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“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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Metadata
- Authors
- Nock, M. K., Hwang, I., Sampson, N. A., & Kessler, R. C.
- Affiliations
- Harvard University (US)
- Corresponding author
- Nock, M K
- Venue
- Molecular Psychiatry
- Published
- 2009-03-31
- Volume
- 15
- Issue
- 8
- Pages
- 868-876
- ISSN
- 1359-4184 (ISSN-L)
- 1476-5578
- 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
- green
- www.ncbi.nlm.nih.gov
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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