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Original Research

Twelve-Month Prevalence of and Risk Factors for Suicide Attempts in the World Health Organization World Mental Health Surveys

Guilherme Borges, ScD; Matthew K. Nock, PhD; Josep M. Haro Abad, MD, PhD; Irving Hwang, MA; Nancy A. Sampson, BA; Jordi Alonso, MD, MPH, PhD; Laura Helena Andrade, MD, PhD; Matthias C. Angermeyer, PhD; Annette Beautrais, PhD; Evelyn Bromet, PhD; Ronny Bruffaerts, PhD; Giovanni de Girolamo, MD; Silvia Florescu, MD; Oye Gureje, MD, PhD, FRCPsych; Chiyi Hu, MD, PhD; Elie G. Karam, MD; Viviane Kovess-Masfety, MD, PhD; Sing Lee, MBBS, FRCPsych; Daphna Levinson, PhD; Maria Elena Medina-Mora, PhD; Johan Ormel, PhD; Jose Posada-Villa, MD; Rajesh Sagar, MD; Toma Tomov, PhD; Hidenori Uda, MD; David R. Williams, PhD, MPH; and Ronald C. Kessler, PhD

Published: August 24, 2010

Article Abstract

Objective: Although suicide is a leading cause of death worldwide, clinicians and researchers lack a data-driven method to assess the risk of suicide attempts. This study reports the results of an analysis of a large cross-national epidemiologic survey database that estimates the 12-month prevalence of suicidal behaviors, identifies risk factors for suicide attempts, and combines these factors to create a risk index for 12-month suicide attempts separately for developed and developing countries.

Method: Data come from the World Health Organization (WHO) World Mental Health (WMH) Surveys (conducted 2001-2007), in which 108,705 adults from 21 countries were interviewed using the WHO Composite International Diagnostic Interview. The survey assessed suicidal behaviors and potential risk factors across multiple domains, including sociodemographic characteristics, parent psychopathology, childhood adversities, DSM-IV disorders, and history of suicidal behavior.

Results: Twelve-month prevalence estimates of suicide ideation, plans, and attempts are 2.0%, 0.6%, and 0.3%, respectively, for developed countries and 2.1%, 0.7%, and 0.4%, respectively, for developing countries. Risk factors for suicidal behaviors in both developed and developing countries include female sex, younger age, lower education and income, unmarried status, unemployment, parent psychopathology, childhood adversities, and presence of diverse 12-month DSM-IV mental disorders. Combining risk factors from multiple domains produced risk indices that accurately predicted 12-month suicide attempts in both developed and developing countries (area under the receiver operating characteristic curve = 0.74-0.80).

Conclusions: Suicidal behaviors occur at similar rates in both developed and developing countries. Risk indices assessing multiple domains can predict suicide attempts with fairly good accuracy and may be useful in aiding clinicians in the prediction of these behaviors.

J Clin Psychiatry

Submitted: December 19, 2008; accepted July 10, 2009.

Online ahead of print: August 24, 2010 (doi:10.4088/JCP.08m04967blu).

Corresponding author: Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115 (

Volume: 71

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