The DOI matches its Crossref record; 46 of the 46 references it cites were found in a registry or an index.
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measuredIn the citing paper
“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]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,845
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.6.617 · Cited by 12,052
Self-citationKessler, R. C., & Üstün, T. B. (2004) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.168 · Cited by 4,771
Self-citationNock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., & Lee, S. (2008) · Epidemiologic Reviews · doi:10.1093/epirev/mxn002 · Cited by 2,897
Self-citationJoiner, T. E. (2007) · Harvard University Press eBooks · doi:10.2307/j.ctvjghv2f · Cited by 2,891
Validity of adult retrospective reports of adverse childhood experiences: review of the evidence
Hardt, J., & Rutter, M. (2004) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2004.00218.x · Cited by 2,827
Cross-national prevalence and risk factors for suicidal ideation, plans and attempts
Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M., Beautrais, A., Bruffaerts, R., Chiu, W. T., de Girolamo, G., Gluzman, S., et al. (2008) · British Journal of Psychiatry · doi:10.1192/bjp.bp.107.040113 · Cited by 2,654
Self-citationSuicide as an outcome for mental disorders: A meta-analysis
Harris, E. C., & Barraclough, B. (1997) · British Journal of Psychiatry · doi:10.1192/bjp.170.3.205 · Cited by 2,589
Prevalence of and Risk Factors for Lifetime Suicide Attempts in the National Comorbidity Survey
Kessler, R. C., Borges, G., & Walters, E. E. (1999) · Archives of General Psychiatry · doi:10.1001/archpsyc.56.7.617 · Cited by 2,514
Self-citationUsing Propensity Scores to Help Design Observational Studies: Application to the Tobacco Litigation
Rubin, D. B. (2001) · Health Services and Outcomes Research Methodology · doi:10.1023/a:1020363010465 · Cited by 2,228
Psychological autopsy studies of suicide: a systematic review.
CAVANAGH, J. T. O., CARSON, A. J., SHARPE, M., & LAWRIE, S. M. (2003) · Psychological Medicine · doi:10.1017/s0033291702006943 · Cited by 2,207
Baumeister, R. F. (1990) · Psychological Review · doi:10.1037/0033-295x.97.1.90 · Cited by 1,919 · cited 1×
“Such an interpretation is consistent with an escape model of suicide, which suggests that people attempt suicide in an effort to escape intolerable distress regardless of the specific source of that distress.(39,40) Such a model also may help explain the strong dose-response relationship observed between number of dis…”
ResultThe American Psychiatric Association (APA)
Strentz, T. (2017) · CRC Press eBooks · doi:10.1201/9781315150581-3 · Cited by 1,841
Toward a clinical model of suicidal behavior in psychiatric patients
Mann, J. J., Waternaux, C., Haas, G. L., & Malone, K. M. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.2.181 · Cited by 1,791
Introduction to Variance Estimation.
King, B. F., & Wolter, K. M. (1987) · Journal of the American Statistical Association · doi:10.2307/2289497 · Cited by 1,377
Kessler, R. C. (2005) · JAMA · doi:10.1001/jama.293.20.2487 · Cited by 1,101
Self-citationHaro, J. M., Arbabzadeh-Bouchez, S., Brugha, T. S., De Girolamo, G., Guyer, M. E., Jin, R., Lepine, J. P., Mazzi, F., Reneses, B., Vilagut, G., et al. (2006) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.196 · Cited by 1,082
Self-citationLogistic regression, survival analysis, and the Kaplan-Meier curve.
Efron, B. (1988) · Journal of the American Statistical Association · doi:10.1080/01621459.1988.10478612 · Cited by 1,065
Reducing Suicide--A National Imperative
(2002) · PsycEXTRA Dataset · doi:10.1037/e719942007-001 · Cited by 947
Affective disorders and suicide risk: a reexamination
Bostwick, J. M., & Pankratz, V. S. (2000) · American Journal of Psychiatry · doi:10.1176/appi.ajp.157.12.1925 · Cited by 878
The US National Comorbidity Survey Replication (NCS‐R): design and field procedures
Kessler, R. C., Berglund, P. A., Chiu, W. T., Demler, O., Heeringa, S. G., Hiripi, E., Jin, R., Pennell, B., Walters, E. E., Zaslavsky, A. M., et al. (2004) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.167 · Cited by 858
Self-citationIntroduction to Variance Estimation
Hidiroglou, M. A., & Wolter, K. M. (1986) · Technometrics · doi:10.2307/1269086 · Cited by 820
Commentary: Suicide as Psychache
SHNEIDMAN, E. S. (1993) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199303000-00001 · Cited by 775
Prediction of Suicide in Psychiatric Patients
Pokorny, A. D. (1983) · Archives of General Psychiatry · doi:10.1001/archpsyc.1983.01790030019002 · Cited by 749
The National Comorbidity Survey Replication (NCS‐R): background and aims
Kessler, R. C., & Merikangas, K. R. (2004) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.166 · Cited by 745
Self-citationBeautrais, A. L., Joyce, P. R., Mulder, R. T., Fergusson, D. M., Deavoll, B. J., & Nightingale, S. (1996) · American Journal of Psychiatry · doi:10.1176/ajp.153.8.1009 · Cited by 654
Family genetic studies, suicide, and suicidal behavior
Brent, D. A., & Mann, J. J. (2005) · American Journal of Medical Genetics Part C Seminars in Medical Genetics · doi:10.1002/ajmg.c.30042 · Cited by 618
Suicidal Ideation and Suicide Attempts in Panic Disorder and Attacks
Weissman, M. M., Klerman, G. L., Markowitz, J. S., & Ouellette, R. (1989) · New England Journal of Medicine · doi:10.1056/nejm198911023211801 · Cited by 602
Borges, G., Angst, J., Nock, M. K., Ruscio, A. M., & Kessler, R. C. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.01.036 · Cited by 334 · cited 2×
“The finding that every mental disorder measured predicts suicide attempts in bivariate analyses replicates results from prior studies.(11,12,20) Our multivariate analysis showed that the incremental predictive effects of individual disorders are much less powerful and that a general pattern of sub-additive interactive…”
BackgroundResultSelf-citationBondy, B., Buettner, A., & Zill, P. (2006) · Molecular Psychiatry · doi:10.1038/sj.mp.4001803 · Cited by 319
Reducing Suicide: A National Imperative
Wong, N. (2003) · American Journal of Psychiatry · doi:10.1176/appi.ajp.160.8.1534 · Cited by 225
Comorbidity of Axis I and Axis II Disorders in Patients Who Attempted Suicide
Hawton, K., Houston, K., Haw, C., Townsend, E., & Harriss, L. (2003) · American Journal of Psychiatry · doi:10.1176/appi.ajp.160.8.1494 · Cited by 197
Comorbidity patterns in adolescents and young adults with suicide attempts
Wunderlich, U., Bronisch, T., & Wïttchen, H. (1998) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s004060050023 · Cited by 166
Diagnostic comorbidity in persons with suicidal ideation and behavior
Rudd, M. D., Dahm, P. F., & Rajab, M. H. (1993) · American Journal of Psychiatry · doi:10.1176/ajp.150.6.928 · Cited by 165
Phillips, M. R., Yang, G., Li, S., & Li, Y. (2004) · The Lancet · doi:10.1016/s0140-6736(04)17061-x · Cited by 147
Angold, A. C., Erkanli, A., Costello, E. J., & Rutter, M. L. (1996) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.1996.tb01457.x · Cited by 139
Familial Pathways to Suicidal Behavior — Understanding and Preventing Suicide among Adolescents
Brent, D. A., & Mann, J. J. (2006) · New England Journal of Medicine · doi:10.1056/nejmp068195 · Cited by 136
Treating Impulsivity and Anxiety in the Suicidal Patient
FAWCETT, J. A. (2001) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2001.tb05800.x · Cited by 109
Suicide: A Four‐pathway Clinical‐Biochemical Model
FAWCETT, J. A., Busch, K. A., Jacobs, D. G., Kravitz, H. M., & Fogg, L. (1997) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1997.tb52366.x · Cited by 105
A Reanalysis of Data from the Epidemiologic Catchment Area Study
Hornig, C. D., & McNally, R. (1995) · The British Journal of Psychiatry · doi:10.1192/bjp.167.1.76 · Cited by 93
Multimorbidity of psychiatric disorders as an indicator of clinical severity
Angst, J., Sellaro, R., & Merikangas, K. R. (2002) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-002-0357-6 · Cited by 80
Panic Attacks and Suicide Attempts in Mid-Adolescence
Pilowsky, D. J., Wu, L.-T. T., & Anthony, J. C. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.10.1545 · Cited by 68
Panic Disorder and Suicide Attempt in the National Comorbidity Survey.
Vickers, K., & McNally, R. J. (2004) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.113.4.582 · Cited by 63
Panic disorder and suicide attempts
Mannuzza, S., Aronowitz, B., Chapman, T. F., Klein, D. F., & Fyer, A. J. (1992) · Journal of Anxiety Disorders · doi:10.1016/0887-6185(92)90038-9 · Cited by 47
Moffitt, T. E., Harrington, H., Caspi, A., Kim-Cohen, J., Goldberg, D., Gregory, A. M., & Poulton, R. (2007) · Archives of General Psychiatry · doi:10.1001/archpsyc.64.6.651 · Cited by 41 · cited 1×
“37,38 These disorders also were among those showing the largest decay in their association with suicide attempts in the presence of comorbid disorders, suggesting they are not uniquely associated with suicide attempts.”
Panic Attacks and Suicide Attempts
Anthony, J. C. (1991) · Archives of General Psychiatry · doi:10.1001/archpsyc.1991.01810360078012 · Cited by 22
Flagged first, then by citations
Research works printed but not linked: 2
- 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). Biometrics Research, New York State Psychiatric Institute: New York, NY, 2002.
- Schlesselman JJ . Case–Control Studies: Design, Conduct, and Analysis. Oxford University Press: New York, NY, 1982.
Cited by
Sorted by citations
The interpersonal theory of suicide.
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. (2010) · Psychological Review · doi:10.1037/a0018697 · Cited by 5,292
Suicide and suicidal behaviour
Turecki, G., & Brent, D. A. (2016) · The Lancet · doi:10.1016/s0140-6736(15)00234-2 · Cited by 2,338
Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013) · JAMA Psychiatry · doi:10.1001/2013.jamapsychiatry.55 · Cited by 1,666
Self-citationTime for united action on depression: a Lancet–World Psychiatric Association Commission
Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02141-3 · Cited by 1,104
Self-citationMental disorders as networks of problems: a review of recent insights
Fried, E. I., van Borkulo, C. D., Cramer, A. O. J., Boschloo, L., Schoevers, R. A., & Borsboom, D. (2016) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-016-1319-z · Cited by 1,144
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
