Research report
Risk factors for suicidality in Europe: Results from the ESEMED study

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Abstract

Background

Precise knowledge of the epidemiology of suicidality provides necessary information for designing prevention programs. The aims of the present study were to investigate the prevalence and correlates of suicidal ideas and attempts in the general population of Europe.

Methods

The European Study on the Epidemiology of Mental Disorders (ESEMED) is a cross-sectional household survey carried out in a probability representative sample of non-institutionalised adults (aged 18 years or older) of six European countries (Belgium, France, Germany, Italy, the Netherlands and Spain). The Composite International Diagnostic Interview (CIDI 3.0) was administered to 21,425 individuals.

Results

Lifetime prevalence of suicidal ideation was 7.8% and of suicidal attempts 1.3%. Being women, younger and divorced or widowed were associated with a higher prevalence of suicide ideation and attempts. Psychiatric diagnoses were strongly related to suicidality. Among them, major depressive episode (Rate ratio 2.9 for lifetime ideas and 4.8 for lifetime attempts), dysthymia (RR 2.0 and 1.6), GAD (RR 1.8 and 2.3 for lifetime), PTSD (RR 1.9 and 2.0) and alcohol dependence (RR 1.7 and 2.5) were the most important. Population attributable risks for lifetime suicidal attempt was 28% for major depression.

Limitations

Information about suicidal ideas and attempts was self reported, psychiatric diagnoses were made using fully structured lay interviews rather than clinician-administered interviews.

Conclusions

In spite of meaningful country variation in prevalence, risk factors for suicidality are consistent in the European countries. Population prevention programmes should focus on early diagnosis and treatment of major depression and alcohol abuse and in those individuals with recent appearance of suicidal ideas.

Introduction

Deaths as a result of self-inflicted injuries account for 1.5% of total deaths for both sexes, have ranked within the leading two causes of death among 15–34-year-old people in a selection of European countries, and are one of the leading causes of death in Europe (Murray and Lopez, 1996). The problem may even be higher than this statistics suggest, as suicide is sometimes hidden in many societies and may be underreported (Phillips and Ruth, 1993). The establishment of universal prevention programs based on the identification of risk factors for suicidal behavior represents a public health priority (Pearson and Brown, 2000). Precise knowledge of the epidemiology of suicidality may provide necessary information for designing such programs.

Previous research has estimated the lifetime prevalence of suicidal ideas to range from 4.8% (Paykel et al., 1974) to 18.5% (Weissman et al., 1999) and the lifetime prevalence of attempted suicide to range between 1.1% (Paykel et al., 1974) and 5.9% (Weissman et al., 1999). However, the differing age ranges, question wording and samples across previous studies make direct comparisons difficult. Multiple risks factors for suicidal ideation and attempts have been reported. The most consistent of these are sociodemographic variables including age, sex, marital status, and religion (Weissman, 1974, Moscicki, 1995, Kessler et al., 2005, Agoub et al., 2006, De Leo et al., 2005). Research has also documented that mental disorders are risk factors for suicidality, especially, major depression, alcohol or drug abuse and dependence, panic disorder, social phobia, and schizophrenia (Kessler et al., 2005, Möller, 2003, Vilhjalmsson et al., 1998, Lewinsohn et al., 1996, Moscicki, 1997).

At the European level, the WHO/EURO multicentre study provided comparable data among countries about suicidality (Platt et al., 1986). However, that study was based on treated samples and it is impossible to extrapolate results to the general population. To our knowledge, there is no community survey that, at the European level, has estimated the prevalence and correlates of suicidal ideas and attempts, and its relationship with mental disorders. The aims of the present study were to do this in general population surveys carried out six European countries.

Section snippets

Methods

The European Study on the Epidemiology of Mental Disorders (ESEMED) is a cross-sectional household survey carried out in a probability representative sample of non-institutionalised adults (aged 18 years or older) in six European countries (Belgium, France, Germany, Italy, the Netherlands and Spain). In total, 21,425 respondents were interviewed between January 2001 and August 2003 and provided data for the project. The overall response rate for the six countries investigated was 61.2%, with

Statistical analysis

The analyses presented here are based on a part II questionnaire, that was administered to 8796 individuals. Cases were weighted to account for the known probability of selection as well as to restore the distribution of the population within each country. In addition, overall estimates were weighted to restore the relative dimension of the population across countries (i.e. German totals represented the highest share, followed by French and Italian, with Belgium representing the least,

Results

The characteristics of the study sample are shown in Table 1. Mean age was 47 years with the majority of respondents being between 35–49 years old. Forty-eight percent of them were male. Most of the subjects were married or living with a partner (67%) and more than half were in paid employment at the time of the interview (57%).

Lifetime prevalence of suicidal ideas was 7.8% and of suicidal attempts 1.8% (Table 1). Lifetime suicidality (i.e., suicide ideation and suicide attempts) was more

Discussion

Lifetime prevalence of suicide ideation in the six European participating countries of our survey was 7.8%. Suicidal ideation can appear at any time in life, and most individuals who report suicidal ideation will never try a suicide attempt. Major depressive episode appeared to be the most important risk factor for lifetime suicide attempt among those examined, with a population attributable risk proportion (PAR) of roughly 28%, which implies that the lifetime prevalence of suicide attempts

Acknowledgements

This project was funded by the European Commission (Contract QLG5-1999-01042), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028; Red Temática RIRAG 03/061), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. ESEMED is carried out in conjunction with the World Health Organization

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