Risk factors for the incidence and persistence of suicide-related outcomes: A 10-year follow-up study using the National Comorbidity Surveys☆
Received 31 October 2006; received in revised form 26 January 2007; accepted 31 January 2007.
Abstract
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.
bUniversidad Autonoma Metropolitana, Mexico City, Mexico
cZurich University Psychiatric Hospital, Zurich, Switzerland
dDepartment of Psychology, Harvard University, Cambridge, MA, United States
eDepartment of Psychology, University of Pennsylvania, Philadelphia, PA, United States
fDepartment of Health Care Policy, Harvard Medical School, Boston, MA, United States
Corresponding author.
☆ Address reprint requests to NCS Coordinator, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston MA 02115; NCS@hcp.med.harvard.edu. Contributors: Guilherme Borges carried out the statistical analyses, collaborated in the literature review, wrote the first draft of the manuscript, and collaborated in revision of the manuscript. Jules Angst, Matthew Nock, and Ayelet Ruscio all collaborated in the literature review, interpretation of results, and revision of the manuscript. Ronald Kessler designed the study and collaborated in the interpretation of results and revision of the manuscript.Conflict of interest: Professor Kessler has been a consultant for Astra Zeneca, Bristol-Myers Squibb, Eli Lilly and Company, GlaxoSmithKline, Pfizer, and Wyeth and has had research support for his epidemiological studies from Bristol-Myers Squibb, Eli Lilly and Company, Ortho-McNeil, Pfizer, and the Pfizer Foundation. All other authors declare that they have no conflicts of interest.
ABSTRACT