TY - JOUR
T1 - Association Between Psychotic Experiences and Subsequent Suicidal Thoughts and Behaviors
T2 - A Cross-National Analysis From the World Health Organization World Mental Health Surveys
AU - World Health Organization World Mental Health Survey Collaborators
AU - Bromet, Evelyn J.
AU - Nock, Matthew K.
AU - Saha, Sukanta
AU - Lim, Carmen C.W.
AU - Aguilar-Gaxiola, Sergio
AU - Al-Hamzawi, Ali
AU - Alonso, Jordi
AU - Borges, Guilherme
AU - Bruffaerts, Ronny
AU - Degenhardt, Louisa
AU - de Girolamo, Giovanni
AU - de Jonge, Peter
AU - Florescu, Silvia
AU - Gureje, Oye
AU - Haro, Josep M.
AU - He, Yanling
AU - Hu, Chiyi
AU - Karam, Elie G.
AU - Kovess-Masfety, Viviane
AU - Lee, Sing
AU - Lepine, Jean Pierre
AU - Mneimneh, Zeina
AU - Navarro-Mateu, Fernando
AU - Ojagbemi, Akin
AU - Posada-Villa, José
AU - Sampson, Nancy A.
AU - Scott, Kate M.
AU - Stagnaro, Juan C.
AU - Viana, Maria C.
AU - Xavier, Miguel
AU - Kessler, Ronald C.
AU - McGrath, John J.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85033592666&partnerID=8YFLogxK
U2 - 10.1001/jamapsychiatry.2017.2647
DO - 10.1001/jamapsychiatry.2017.2647
M3 - Article
C2 - 28854302
AN - SCOPUS:85033592666
VL - 74
SP - 1136
EP - 1144
JO - JAMA Psychiatry
JF - JAMA Psychiatry
IS - 11
ER -
