General psychopathology most strongly mediates the effect of psychiatric disorders on risk for suicide attempt, according to study data published in the Journal of Clinical Psychiatry.
Data were abstracted from Wave 1 and Wave 2 of the National Epidemiologic Study on Alcohol and Related Conditions (NESARC), a nationally representative face-to-face survey of the US adult population conducted by the National Institute on Alcoholism and Alcohol Abuse in 2001 to 2002 (Wave 1) and 2004 to 2005 (Wave 2). Wave 1 captured psychiatric disorders in participants per the Alcohol Use Disorder and Associated Disabilities Interview Schedule. Wave 2 surveys captured incident cases of suicide attempt since the baseline interview, as well as lifetime history of suicide attempt. The present analysis includes data on participants who completed interviews for both Wave 1 and Wave 2 (N=34,653). Multiple-group structural equation modeling was performed to examine the effects of psychiatric diagnosis on the 3-year incidence of suicide attempts in the 4 following age groups: 18 to 30 years, 31 to 40 years, 41 to 49 years, and ≥50 years.
Among the total population, the 3-year incidence rate of suicide attempt was 0.67%±0.05% (n=253). This rate was 1.0%±0.13% (n=77) for the 18- to 30-year-old age group, 0.96%±14% (n=73) for the 31- to 40-year-old age group, 0.81%±0.14% (n=63) for the 41- to 49-year-old age group, and 0.22%±0.05% (n=40) for the ≥50-year-old age group. Among participants who attempted suicide, the 12-month prevalence rates of any psychiatric disorder were 75.0%±5.8 in the youngest age group, 60.4%±8.3% in participants aged 31 to 40 years, 81.2%±5.4% in participants aged 41 to 49 years, and 49.7%±9.8% in the oldest age group.
In each age group, most psychiatric disorders were associated with increased risk for suicide attempt. The most common psychiatric diagnosis was major depressive episode for each age group, with prevalence rates ranging from 22.2% in the oldest age group to 46.1% in the youngest age group. After adjustments for sociodemographic factors and prior suicide attempt, only the general psychopathology factor, which represents the shared effect across all psychiatric disorders, increased the 3-year risk for suicide attempt in all age groups. The magnitude of this effect was stronger in younger age groups compared with older age groups (P <.01). Specifically, the standardized effect was significantly greater among individuals ≤50 years compared with individuals ≥50 years (P =.02). No individual psychiatric disorder had significant added effects on suicide risk.
These data emphasize the necessity of psychiatric screening for patients of all ages to mediate suicide risk. Further research is necessary to identify effective suicide prevention strategies centered around reducing general psychopathology.
Pascal de Raykeer R, Hoertel N, Blanco C, et al. Effects of psychiatric disorders on suicide attempt: similarities and differences between older and younger adults in a national cohort study. J Clin Psychiatry. 2018;79(6):17m11911.