1. Self-Destructive Behaviors: Definitions & Rates Prof. Matthew K. Nock September 14, 2009

2. Public Health Context

3. CountryYearMalesFemales Ukraine200052.110.0 Japan200035.213.4 Belgium199731.211.4 France199926.19.4 Bulgaria200225.68.3 Romania200223.94.7 China (HK SAR)199916.79.8 China (rural/urban)199913.014.8 Germany200120.47.0 Australia200120.15.3 Ireland200020.34.3 New Zealand200019.84.2 India199812.29.1 United States200017.14.0 Netherlands200012.76.2 Spain200013.14.0 Suicide Rates (per 100,000) by Country: WHO 2005

4. CountryYearMalesFemales Italy200010.93.5 Israel19999.82.3 Costa Rica19959.72.1 Brazil19956.61.8 Panama19875.61.9 Colombia19945.51.5 Mexico19955.41.0 Peru19890.60.4 Indonesia-- Nigeria-- South Africa-- Turkey-- Suicide Rates (per 100,000) by Country: WHO 2005

8. U.S. Suicide Rate by Age, Gender & Race

10. U.S. Suicide Rate by Age & Sex Over Time

11. U.S. Suicide Rate by Region

12. U.S. Suicide Rate by Age, Gender & Race

16. U.S. Suicide Rate by Method & Gender

17. Death Rates of U.S. Youth

18. Suicide Rates by Month

19. Current Context Suicide & NSSI are very difficult to predict & prevent

20. 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

21. Epidemiology of Suicidal Outcomes What is the prevalence of suicide ideation, plans, and attempts? What are the onset, course, and risk factors?

22. Epidemiology of Suicidal Outcomes * * * * * * * * * * * * * * * * * * * * * ** * * *

23. 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% (3.1 China - 15.9 New Zealand ) Suicide Plan3.1% (0.7 Italy - 5.6 New Zealand ) Suicide Attempt2.7% (0.9 Italy - 5.0 USA ) Nock et al. (2008). British Journal of Psychiatry N = 84,850; 17 Countries

24. 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

25. Epidemiology of Suicidal Outcomes Nock et al. (2008). British Journal of Psychiatry

26. 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

27. Epidemiology of Suicidal Outcomes Nock et al. (2008). British Journal of Psychiatry

28. 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

29. Epidemiology of Suicidal Outcomes Nock et al. (2008). British Journal of Psychiatry

30. 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.

31. 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)

32. 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)

33. Self-Injury Rate by Sex

34. Self-Injury Rate Over Time

35. Rate of NSSI among U.S. Youth (Hilt, Nock, Lloyd-Richardson & Prinstein, 2008)

36. Self-Destructive Behaviors: Definitions & Rates Prof. Matthew K. Nock September 14, 2009