Most mental disorders, when examined independently, are associated with an elevated risk for suicide attempt. However, mental disorders often co-occur, and that co-occurrence is well explained by models where specific mental disorders are understood as manifestations of latent dimensions of psychopathology. To date, it remains unclear whether the risk of suicide attempt is due to specific mental disorders, to specific dimensions of psychopathology (that is, internalizing and externalizing dimensions), to a general psychopathology factor or to a combination of these explanations. In a large nationally representative prospective survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we used structural equation modeling to examine the shared and specific effects of Axis I and Axis II disorders on the occurrence of suicide attempts in the general population and among individuals with a lifetime history of suicidal ideation. Effects of mental disorders on the risk of suicide attempt were exerted almost exclusively through a general psychopathology factor representing the shared effect across all mental disorders. Effects of remitted psychiatric disorders on the risk of suicide attempt were fully mediated by current mental disorders. Similar patterns of associations were found in individuals with suicidal ideation. These results held when using different approaches to modeling psychiatric comorbidity. Our findings underscore the importance of adopting dimensional approaches to comorbidity in the study of suicidal behavior. Because mental disorders increase the risk of suicide attempt through a general psychopathology liability, this dimension should be considered as an important therapeutic target to substantially advance suicide prevention.
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This study was supported by NIH grants DA019606, MH076051 and MH082773 and the New York State Psychiatric Institute (Drs Blanco, Oquendo and Wall), NIDA grant 1F32DA036431 (Dr Kerridge), and a fellowship grant from Public Health Expertise (Dr Hoertel). The sponsors had no additional role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript.
Dr Oquendo receives royalties for the commercial use of the C-SSRS and her family owns stock in Bristol Myers Squibb. Dr Limosin is a member of the speakers/advisory boards for Janssen, Euthérapie, Lundbeck and Roche. Other authors report no conflicts of interest.
Supplementary Information accompanies the paper on the Molecular Psychiatry website
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Hoertel, N., Franco, S., Wall, M. et al. Mental disorders and risk of suicide attempt: a national prospective study. Mol Psychiatry 20, 718–726 (2015). https://doi.org/10.1038/mp.2015.19
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