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Cross-national prevalence and risk factors for suicidal ideation, plans and attempts

Published online by Cambridge University Press:  02 January 2018

Matthew K. Nock*
Department of Psychology, Harvard University, Massachusetts, USA
Guilherme Borges
Department of Epidemiology, National Institute of Psychiatry and Universidad Autonoma Metropolitana, Mexico City, Mexico
Evelyn J. Bromet
Department of Psychiatry, State University of New York, Stony Brook, USA
Jordi Alonso
Health Services Research Unit, Institut Municipal d'Investigacio Medica IMIM, Barcelona, Spain
Matthias Angermeyer
University of Leipzig, Department of Psychiatry, Leipzig, Germany
Annette Beautrais
Christchurch School of Medicine & Health Sciences, New Zealand
Ronny Bruffaerts
Department of Neurosciences and Psychiatry, University Hospitals, Gasthuisberg, Belgium
Wai Tat Chiu
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
Giovanni de Girolamo
Department of Mental Health, AUSL di Bologna, Bologna, Italy
Semyon Gluzman
Ukrainian Psychiatric Association, Kyiv, Ukraine
Ron de Graaf
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
Oye Gureje
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
Josep Maria Haro
Sant Joan de Deu-SSM, Barcelona, Spain
Yueqin Huang
Institute of Mental Health, Peking University, People's Republic of China
Elie Karam
Department of Psychiatry and Psychology, St George Hospital University Medical Center, Beirut, Lebanon
Ronald C. Kessler
Department of Psychology, Harvard University, Massachusetts, USA
Jean Pierre Lepine
Hospital Fernand Widal, Paris, France
Daphna Levinson
Research and Planning, Mental Health Services, Ministry of Health, Jerusalem, Israel
Maria Elena Medina-Mora
Department of Epidemiology, National Institute of Psychiatry and Universidad Autonoma Metropolitana, Mexico City, Mexico
Yutaka Ono
Keio University, Tokyo, Japan
José Posada-Villa
Colegio Mayor de Cundinamarca University, Saldarriaga Concha Foundation, Bogota, Colombia
David Williams
Harvard University School of Public Health, Boston, Massachusetts, USA
Matthew K. Nock, PhD, Department of Psychology, Harvard University, 33 Kirkland Street, 1280 Cambridge, MA 02138, USA. Email:
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Suicide is a leading cause of death worldwide; however, the prevalence and risk factors for the immediate precursors to suicide – suicidal ideation, plans and attempts – are not well-known, especially in low- and middle-income countries.


To report on the prevalence and risk factors for suicidal behaviours across 17 countries.


A total of 84 850 adults were interviewed regarding suicidal behaviours and socio-demographic and psychiatric risk factors.


The cross-national lifetime prevalence of suicidal ideation, plans, and attempts is 9.2% (s.e.=0.1), 3.1% (s.e.=0.1), and 2.7% (s.e.=0.1). Across all countries, 60% of transitions from ideation to plan and attempt occur within the first year after ideation onset. Consistent cross-national risk factors included being female, younger, less educated, unmarried and having a mental disorder. Interestingly, the strongest diagnostic risk factors were mood disorders in high-income countries but impulse control disorders in low- and middle-income countries.


There is cross-national variability in the prevalence of suicidal behaviours, but strong consistency in the characteristics and risk factors for these behaviours. These findings have significant implications for the prediction and prevention of suicidal behaviours.

Copyright © Royal College of Psychiatrists, 2008 


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