Self-Destructive Behaviors: Definitions & Rates Prof. Matthew K. Nock September 14, 2009.
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Transcript of Self-Destructive Behaviors: Definitions & Rates Prof. Matthew K. Nock September 14, 2009.
Self-Destructive Behaviors:Definitions & Rates
Prof. Matthew K. NockSeptember 14, 2009
Public Health Context
Country Year Males Females
Ukraine 2000 52.1 10.0
Japan 2000 35.2 13.4
Belgium 1997 31.2 11.4
France 1999 26.1 9.4
Bulgaria 2002 25.6 8.3
Romania 2002 23.9 4.7
China (HK SAR) 1999 16.7 9.8
China (rural/urban) 1999 13.0 14.8
Germany 2001 20.4 7.0
Australia 2001 20.1 5.3
Ireland 2000 20.3 4.3
New Zealand 2000 19.8 4.2
India 1998 12.2 9.1
United States 2000 17.1 4.0
Netherlands 2000 12.7 6.2
Spain 2000 13.1 4.0
Suicide Rates (per 100,000) by Country: WHO 2005
Country Year Males Females
Italy 2000 10.9 3.5
Israel 1999 9.8 2.3
Costa Rica 1995 9.7 2.1
Brazil 1995 6.6 1.8
Panama 1987 5.6 1.9
Colombia 1994 5.5 1.5
Mexico 1995 5.4 1.0
Peru 1989 0.6 0.4
Indonesia -- -- --
Nigeria -- -- --
South Africa -- -- --
Turkey -- -- --
Suicide Rates (per 100,000) by Country: WHO 2005
U.S. Suicide Rate by Age, Gender & Race
U.S. Suicide Rate by Age, Gender & Race
U.S. Suicide Rate by Age & Sex Over Time
U.S. Suicide Rate by Region
U.S. Suicide Rate by Age, Gender & Race
U.S. Suicide Rate by Age, Gender & Race
U.S. Suicide Rate by Age, Gender & Race
U.S. Suicide Rate by Age, Gender & Race
U.S. Suicide Rate by Method & Gender
Death Rates of U.S. Youth
Suicide Rates by Month
Current Context
• Suicide & NSSI are very difficult to predict & prevent
Classifying Self-Injurious Thoughts and Behaviors
• Common terms: “suicidality” …“deliberate self-harm”… “parasuicide”…
• More specific terms and definitions:
– Suicide ideation: thoughts of intentionally ending one’s own life
– Suicide plan: selection of method with some intent to act in the future
– Suicide attempt: self-injurious behavior with intent to die
– Non-suicidal self-injury (NSSI): self-injury with no intent to die
Nock & Kessler (2006) J Abnormal Psychology
Nock & Kazdin (2002) J Clinical Child & Adolescent Psychology
Epidemiology of Suicidal Outcomes
• What is the prevalence of suicide ideation, plans, and attempts?• What are the onset, course, and risk factors?
Epidemiology of Suicidal Outcomes
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Epidemiology of Suicidal Outcomes
• What is the prevalence of suicide ideation, plans, and attempts?• What are the onset, course, and risk factors?
• WHO World Mental Health Survey Initiative (Kessler et al):
nationally representative survey in 28 countries (N ~ 250,000)
Prevalence
Estimate Range
Suicide Ideation 9.2% (3.1China - 15.9New Zealand)
Suicide Plan 3.1% (0.7Italy - 5.6New Zealand)
Suicide Attempt 2.7% (0.9Italy - 5.0USA)
Nock et al. (2008). British Journal of Psychiatry
N = 84,850; 17 Countries
Epidemiology of Suicidal Outcomes
• Although variability in prevalence of suicidal outcomes, there is consistency in:– Age-of-onset (AOO) of suicidal outcomes
Nock et al. (2008). British Journal of Psychiatry
Epidemiology of Suicidal Outcomes
Nock et al. (2008). British Journal of Psychiatry
Epidemiology of Suicidal Outcomes
• Although variability in prevalence of suicidal outcomes, there is consistency in:– Age-of-onset (AOO) of suicidal outcomes
– Conditional probabilities of transition from ideation to plans (33.6%) and attempts (29.0%)
– Speed of transition from ideation to plans and attempts
Nock et al. (2008). British Journal of Psychiatry
Epidemiology of Suicidal Outcomes
Nock et al. (2008). British Journal of Psychiatry
Epidemiology of Suicidal Outcomes
• Although variability in prevalence of suicidal outcomes, there is consistency in:– Age-of-onset (AOO) of suicidal outcomes
– Conditional probabilities of transition from ideation to plans (33.6%) and attempts (29.0%)
– Speed of transition from ideation to plans and attempts
– Risk factors for suicide ideation, plans, and attempts• Female, younger age, unmarried• Presence of mental disorders
Nock et al. (2008). British Journal of Psychiatry
Epidemiology of Suicidal Outcomes
Nock et al. (2008). British Journal of Psychiatry
Predictors of Transition from Suicide Ideation to Attempt
Nock et al. (2009). Molecular Psychiatry (US)
Nock et al. (2009). PLoS Medicine (Cross-nationally)
Prediction of first onset of suicide ideation and attempts in the NCS-R
Suicide
Ideation
Attempts among
Ideators
Depression (MDD)
Anxiety (PTSD)
Conduct (CD)
Alcohol (Abuse/Dep)
…Values are ORs from multivariate survival models predicting ideation in the total sample (column 1), and unplanned attempts among ideators (column 2) in the NCS-R. Models included 16 disorders– only 4 shown here.
Predictors of Transition from Suicide Ideation to Attempt
Prediction of first onset of suicide ideation and attempts in the NCS-R
Suicide
Ideation
Attempts among
Ideators
Depression (MDD) 2.3*
Anxiety (PTSD) 1.5*
Conduct (CD) 1.5*
Alcohol (Abuse/Dep)
…
1.8*
Values are ORs from multivariate survival models predicting ideation in the total sample (column 1), and unplanned attempts among ideators (column 2) in the NCS-R. Models included 16 disorders– only 4 shown here.
Nock et al. (2009). Molecular Psychiatry (US)
Nock et al. (2009). PLoS Medicine (Cross-nationally)
Predictors of Transition from Suicide Ideation to Attempt
Prediction of first onset of suicide ideation and attempts in the NCS-R
Suicide
Ideation
Attempts among
Ideators
Depression (MDD) 2.3* 1.0
Anxiety (PTSD) 1.5* 2.4*
Conduct (CD) 1.5* 2.2*
Alcohol (Abuse/Dep)
…
1.8* 2.9*
Values are ORs from multivariate survival models predicting ideation in the total sample (column 1), and unplanned attempts among ideators (column 2) in the NCS-R. Models included 16 disorders– only 4 shown here.
Nock et al. (2009). Molecular Psychiatry (US)
Nock et al. (2009). PLoS Medicine (Cross-nationally)
Self-Injury Rate by Sex
Self-Injury Rate Over Time
Rate of NSSI among U.S. Youth
(Hilt, Nock, Lloyd-Richardson & Prinstein, 2008)
Percentage of preadolescents who reported engagement in NSSI (N = 508)
7.7 6.5 8.9 7.6 1016.7
7.7 6.6 7.3 9.3
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Self-Destructive Behaviors:Definitions & Rates
Prof. Matthew K. NockSeptember 14, 2009