Journal
PLOS ONE
Volume 5, Issue 5, Pages -Publisher
PUBLIC LIBRARY SCIENCE
DOI: 10.1371/journal.pone.0010574
Keywords
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Categories
Funding
- United States National Institute of Mental Health [R01MH070884, R01MH077883]
- John D. and Catherine T. MacArthur Foundation
- Pfizer Foundation
- US Public Health Service [R13-MH066849, R01-MH069864, R01 DA016558]
- Fogarty International Center [FIRCA R03-TW006481]
- Pan American Health Organization
- Eli Lilly and Company Foundation
- Ortho-McNeil Pharmaceutical, Inc.
- GlaxoSmithKline
- Bristol-Myers Squibb
- State of Sao Paulo Research Foundation (FAPESP) [03/00204-3]
- Ministry of Health
- National Center for Public Health Protection
- Shenzhen Bureau of Health
- Shenzhen Bureau of Science, Technology, and Information
- Ministry of Social Protection
- European Commission [QLG5-1999-01042, SANCO 2004123]
- Piedmont Region (Italy)
- Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III, Spain [FIS 00/0028]
- Ministerio de Ciencia y Tecnologia, Spain [SAF 2000-158-CE]
- Departament de Salut, Generalitat de Catalunya, Spain
- Instituto de Salud Carlos III [CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP]
- WHO (India)
- Israel National Institute for Health Policy and Health Services Research
- National Insurance Institute of Israel
- Japan Ministry of Health, Labour and Welfare [H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013]
- Lebanese Ministry of Public Health
- WHO (Lebanon)
- Fogarty International
- Janssen Cilag
- Eli Lilly
- Roche
- Novartis
- National Institute of Psychiatry Ramon de la Fuente [INPRFMDIES 4280]
- National Council on Science and Technology [CONACyT-G30544-H]
- New Zealand Ministry of Health
- Alcohol Advisory Council
- Health Research Council
- WHO (Geneva)
- WHO (Nigeria)
- Federal Ministry of Health, Abuja, Nigeria
- Ministry of Public Health (former Ministry of Health)
- Astrazeneca
- Jazz Pharmaceuticals
- Johnson Johnson
- Lundbeck
- Orion
- Pfizer
- Pharmacia
- Servier
- Solvay
- Sumitomo
- Takeda
- Tikvah
- Wyeth
- Ortho-McNeil Pharmaceuticals
- Sanofi-Aventis
- Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [03/00204-3] Funding Source: FAPESP
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Background: Community 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 Findings: Data 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/Significance: This 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.
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