complicated by the difficulties in defining suicide attempts as distinct from self-mutilation and/or other self-destructive behaviors including risk-taking behaviors (Poussaint and Alexander, 2000). Data from the National Comorbidity Survey (NCS) reveal that serious suicide attempters closely resemble suicide completers (Molnar et al., 2001). For men, substance abuse disorders were associated with a 6.2 times greater risk of serious suicide attempts, and mood disorders were associated with a 13.5 times greater risk. Women with substance abuse disorders had a 4.4 times greater risk of a serious suicide attempt, a 4.8 times risk with anxiety disorders (excluding PTSD), and an 11.8 time greater risk with a mood disorder. Overall, this study found that between 74 and 80 percent of the population attributable risk (PAR1) for serious suicide attempts was accounted for by psychiatric illness.

Psychiatric disorders are diagnosed through interviews, including current and past behaviors, moods, and thoughts. The psychological autopsy technique is used to make post-humous diagnoses when there is no medical history of mental illness available (see Chapter 10). Diagnostic criteria used in the United States are those in the Diagnostic and Statistical Manual developed through a task force overseen by the American Psychiatric Association. The version used at this writing is the DSM-IV (APA, 1994). The DSM-IV provides five axes to describe the individual’s functioning. The mental and substance use disorders are coded on Axis I or Axis II. The Axis I disorders most frequently associated with suicide (also referred to as the major or serious mental disorders) include schizophrenia, bipolar disorder, depressive disorders, and alcohol and substance use disorders. The Axis II disorders are the personality disorders. Borderline personality and antisocial personality disorders are those most frequently associated with suicide.

Mood Disorders

Suicides in many nations including the United States are most commonly associated with a diagnosis of a mood disorder in adults (Lönnqvist, 2000) and adolescents (Goldman and Beardslee, 1999). Best estimates of lifetime risk of suicide for those with mood disorders is approximately 4 percent (see Chapter 10 for discussion of risk calculations). Estimated rates vary greatly depending on the severity of the illness (Goodwin and Jamison, 1990). These disorders are very common in the United States, with approximately 18.8 million American adults (Narrow, unpublished, cited by NIMH), or about 9.5 percent of those 18 and older


Population-attributable risk expresses the proportion of an outcome that could be eliminated if the risk factor were removed.

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