Department of Economics and Business Economics

Association Between Psychotic Experiences and Subsequent Suicidal Thoughts and Behaviors: A Cross-National Analysis From the World Health Organization World Mental Health Surveys

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Evelyn J Bromet, Department of Psychiatry, School of Medicine, State University of New York at Stony Brook
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  • Matthew K Nock, Psychology Department, Harvard University, Cambridge, Massachusetts.
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  • Sukanta Saha, 1] Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia [2] Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.
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  • Carmen C W Lim, 1] Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia [2] Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.
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  • Sergio Aguilar-Gaxiola, Center for Reducing Health Disparities, University of California-Davis Health System, Sacramento.
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  • Ali Al-Hamzawi, College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq.
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  • Jordi Alonso, Centros de Investigación Biomédica en Red en Epidemiología y Salud Pública, Barcelona, Spain.
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  • Guilherme Borges, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico.
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  • Ronny Bruffaerts, Campus Gasthuisberg, Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Leuven, Belgium.
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  • Louisa Degenhardt, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
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  • Giovanni de Girolamo, Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre, Brescia, Italy.
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  • Peter de Jonge, Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical, Center Groningen, Groningen, The Netherlands.
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  • Silvia Florescu, National School of Public Health, Management and Professional Development, Bucharest, Romania.
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  • Oye Gureje, Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
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  • Josep M Haro, Parc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica en Red en Salud Mental, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain.
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  • Yanling He, Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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  • Chiyi Hu, Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China.
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  • Elie G Karam, Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon.
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  • Viviane Kovess-Masfety, Ecole des Hautes Etudes en Santé Publique (EHESP), Paris Descartes University, Paris, France.
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  • Sing Lee, Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong.
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  • Jean-Pierre Lepine, Hôpital Lariboisière-Fernand Widal, Assistance Publique Hôpitaux de Paris, Universités Paris Descartes-Paris Diderot, INSERM UMR-S 1144, Paris, France.
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  • Zeina Mneimneh, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.
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  • Fernando Navarro-Mateu, Unidad de Docencia, Investigación y Formación en Salud Menta, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública-Murcia, Murcia, Spain.
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  • Akin Ojagbemi, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
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  • José Posada-Villa, Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia.
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  • Nancy A Sampson, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
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  • Kate M Scott, Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand.
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  • Juan C Stagnaro, Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
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  • Maria C Viana, Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil.
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  • Miguel Xavier, Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, Lisbon, Portugal.
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  • Ronald C Kessler, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
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  • John J McGrath
  • World Health Organization World Mental Health Survey Collaborators

Importance: Community-based studies have linked psychotic experiences (PEs) with increased risks of suicidal thoughts and behaviors (STBs). However, it is not known if these associations vary across the life course or if mental disorders contribute to these associations.

Objective: To examine the temporal association between PEs and subsequent STBs across the life span as well as the influence of mental disorders (antecedent to the STBs) on these associations.

Design, Setting, and Participants: A total of 33 370 adult respondents across 19 countries from the World Health Organization World Mental Health Surveys were assessed for PEs, STBs (ie, ideation, plans, and attempts), and 21 DSM-IV mental disorders. Discrete-time survival analysis was used to investigate the associations of PEs with subsequent onset of STBs.

Main Outcomes and Measures: Prevalence and frequency of STBs with PEs, and odds ratios and 95% CIs.

Results: Of 33 370 included participants, among those with PEs (n = 2488), the lifetime prevalence (SE) of suicidal ideation, plans, and attempts was 28.5% (1.3), 10.8% (0.7), and 10.2% (0.7), respectively. Respondents with 1 or more PEs had 2-fold increased odds of subsequent STBs after adjusting for antecedent or intervening mental disorders (suicidal ideation: odds ratio, 2.2; 95% CI, 1.8-2.6; suicide plans: odds ratio, 2.1; 95% CI, 1.7-2.6; and suicide attempts: odds ratio, 1.9; 95% CI, 1.5-2.5). There were significant dose-response relationships of number of PE types with subsequent STBs that persisted after adjustment for mental disorders. Although PEs were significant predictors of subsequent STB onset across all life stages, associations were strongest in individuals 12 years and younger. After adjustment for antecedent mental disorders, the overall population attributable risk proportions for lifetime suicidal ideation, plans, and attempts associated with temporally prior PEs were 5.3%, 5.7%, and 4.8%, respectively.

Conclusions and Relevance: Psychotic experiences are associated with elevated odds of subsequent STBs across the life course that cannot be explained by antecedent mental disorders. These results highlight the importance of including information about PEs in screening instruments designed to predict STBs.

Original languageEnglish
JournalJAMA Psychiatry
Volume74
Issue11
Pages (from-to)1136-1144
ISSN0003-990X
DOIs
Publication statusPublished - 2017

    Research areas

  • Journal Article

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