Cross-National Analysis of the Associations between Traumatic Events and Suicidal Behavior: Findings from the WHO World Mental Health Surveys

Abstract

BackgroundCommunity and clinical data have suggested there is an association between trauma exposure and suicidal behavior (i.e., suicide ideation, plans and attempts). However, few studies have assessed which traumas are uniquely predictive of: the first onset of suicidal behavior, the progression from suicide ideation to plans and attempts, or the persistence of each form of suicidal behavior over time. Moreover, few data are available on such associations in developing countries. The current study addresses each of these issues.Methodology/Principal FindingsData on trauma exposure and subsequent first onset of suicidal behavior were collected via structured interviews conducted in the households of 102,245 (age 18+) respondents from 21 countries participating in the WHO World Mental Health Surveys. Bivariate and multivariate survival models tested the relationship between the type and number of traumatic events and subsequent suicidal behavior. A range of traumatic events are associated with suicidal behavior, with sexual and interpersonal violence consistently showing the strongest effects. There is a dose-response relationship between the number of traumatic events and suicide ideation/attempt; however, there is decay in the strength of the association with more events. Although a range of traumatic events are associated with the onset of suicide ideation, fewer events predict which people with suicide ideation progress to suicide plan and attempt, or the persistence of suicidal behavior over time. Associations generally are consistent across high-, middle-, and low-income countries.Conclusions/SignificanceThis study provides more detailed information than previously available on the relationship between traumatic events and suicidal behavior and indicates that this association is fairly consistent across developed and developing countries. These data reinforce the importance of psychological trauma as a major public health problem, and highlight the significance of screening for the presence and accumulation of traumatic exposures as a risk factor for suicide ideation and attempt.

Characterizing Alcohol Use Disorders and Suicidal Ideation in Young Women

“…In a study of World Mental Health Survey data, of all traumatic events correlated with suicidal behavior (including SI), sexual violence was the most prominent (Stein et al, 2010). This also is consistent with a recent large-scale study of the relationship between gender-based violence and mental health in women.…”

The association between different traumatic life events and suicidality

“…Similarly, studies have found strong associations between interpersonal trauma and suicidality, especially sexual trauma (Stein et al, 2010) and childhood trauma (Afifi et al, 2016; Dube et al, 2001). Among those who had experienced sexual trauma or childhood trauma in our study, we found an association with suicidality in both genders, which was stronger for men.…”

“…The risk of suicidality may also vary according to type of traumatic event. For example, a study based on the WHO’s mental health surveys implemented in 21 countries ( n  = 102,245) and investigating a range of traumatic events and suicidal behaviour (Stein et al, 2010) found that the strongest associations were found for violence-related events. In addition, previous studies have shown increased risk of suicidal behaviour subsequent to adverse and traumatic life events during childhood (Afifi et al, 2016; Bruffaerts et al, 2010), for both suicidal ideation (Stansfeld et al, 2017) and suicide attempts (Dube et al, 2001; Enns et al, 2006; Ford & Gomez, 2015).…”

Risk for suicidal behaviors associated with PTSD, depression, and their comorbidity in the U.S. Army

“…If both PTSD and depression were eliminated, a full 45% of past-year suicidality might be prevented. In a previous investigation of the association between traumatic events and suicidality, which involved 102,245 respondents (age 18 þ) from 21 countries participating in the WHO World Mental Health Surveys (Stein et al, 2010), PARP results suggested that 15.4% of all suicidal ideation and 22.1% of suicide attempts were attributable to traumatic events. In the only prior study to examine PARPs for both PTSD and depression in association with suicidality (Bolton and Robinson, 2010), results suggested that PTSD accounted for 6.3% of all suicide attempts, while 26.6% of all suicide attempts were attributable to depression.…”