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

Year: 2017
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Bromet EJ, Nock MK, Saha S, Lim CCW, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Borges G, Bruffaerts R, Degenhardt L, de Girolamo G, de Jonge P, Florescu S, Gureje O, Haro JM, He Y, Hu C, Karam EG, Kovess-Masfety V, Lee S, Lepine J, Mneimneh Z, Navarro-Mateu F, Ojagbemi A, Posada-Villa J, Sampson NA, Scott KM, Stagnaro JC, Viana MC, Xavier M, Kessler RC, McGrath JJ, for the World Health Organization World Mental Health Survey Collaborators (2017).


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 lifecourse orifmental disorders contribute to these associations. OBJECTIVE: To examine the temporal association between PEs and subsequent STBs across the lifespan as well as the influence of mental disorders(antecedent to the STBs)on these associations. DESIGN,SETTING,ANDPARTICIPANTS: A total of 33370 adult respondents across 19 countries from the World Health Organization World Mental Health Surveys were assessed for PEs, STBs(ie,ideation,plans,andattempts),and 21 DSM-IV mental disorders. Discrete-time survival analysis was used to investigate the associations of PEs with subsequent onset of STBs. MAINOUTCOMESANDMEASURES: Prevalence and frequency of STBs with PEs,and odds ratios and 95% CIs. RESULTS: Of 33370 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 PE shad2-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 lifestages,associations were strongest in individuals12 years and younger.After adjustment for antecedentmental disorders,the overall population attributable risk proportions for lifetime suicidal ideation,plans,and attempts associated with temporally prior PEs were5.3%,5.7%,and4.8%,respectively. CONCLUSIONS AND RELEVANCE: Psychotic experiences are associated with elevated odds of subsequent STBs across thelifecourse that cannot be explained by antecedentmental disorders.These results high light the importance of including information about PEs in screening instruments designed to predict STBs.


Other,Mental Health Around the World


Psychotic Experiences,Community-based, DSM, WHO,STBs, Prevalence, PEs
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