Evelyn J Bromet1, Matthew K Nock2, Sukanta Saha3, Carmen C W Lim3, Sergio Aguilar-Gaxiola4, Ali Al-Hamzawi5, Jordi Alonso6,7,8, Guilherme Borges9, Ronny Bruffaerts10, Louisa Degenhardt11, Giovanni de Girolamo12, Peter de Jonge13,14, Silvia Florescu15, Oye Gureje16, Josep M Haro17, Yanling He18, Chiyi Hu19, Elie G Karam20,21, Viviane Kovess-Masfety22, Sing Lee23, Jean-Pierre Lepine24, Zeina Mneimneh25, Fernando Navarro-Mateu26, Akin Ojagbemi27, José Posada-Villa28, Nancy A Sampson29, Kate M Scott30, Juan C Stagnaro31, Maria C Viana32, Miguel Xavier33, Ronald C Kessler29, John J McGrath34,35,36. 1. Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York. 2. Psychology Department, Harvard University, Cambridge, Massachusetts. 3. Queensland Centre for Mental Health Research, Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia. 4. Center for Reducing Health Disparities, University of California-Davis Health System, Sacramento. 5. College of Medicine, Al-Qadisiya University, Diwaniya Governorate, Iraq. 6. Health Services Research Unit, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain. 7. Pompeu Fabra University, Barcelona, Spain. 8. Centros de Investigación Biomédica en Red en Epidemiología y Salud Pública, Barcelona, Spain. 9. National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico. 10. Universitair Psychiatrisch Centrum, Katholieke Universiteit Leuven, Campus Gasthuisberg, Leuven, Belgium. 11. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia. 12. Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico-St John of God Clinical Research Centre, Brescia, Italy. 13. Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, the Netherlands. 14. Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands. 15. National School of Public Health, Management, and Professional Development, Bucharest, Romania. 16. Department of Psychiatry, University College Hospital, Ibadan, Nigeria. 17. Parc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica en Red en Salud Mental, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain. 18. Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. 19. Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen, China. 20. Department of Psychiatry and Clinical Psychology, Faculty of Medicine, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon. 21. Institute for Development, Research, Advocacy, and Applied Care, Beirut, Lebanon. 22. Ecole des Hautes Etudes en Santé Publique, Paris Descartes University, Paris, France. 23. Department of Psychiatry, Chinese University of Hong Kong, Hong Kong. 24. Hôpital Lariboisière-Fernand Widal, Assistance Publique Hôpitaux de Paris, Universités Paris Descartes-Paris Diderot, INSERM UMR-S 1144, Paris, France. 25. Survey Research Center, University of Michigan, Ann Arbor. 26. 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. 27. Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria. 28. Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia. 29. Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts. 30. Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand. 31. Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina. 32. Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil. 33. Chronic Diseases Research Center, Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, Lisbon, Portugal. 34. Queensland Centre for Mental Health Research, University of Queensland, Brisbane, Queensland, Australia. 35. Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia. 36. National Centre for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Aarhus, Denmark.
Abstract
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.
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.
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