Psychological Medicine

Prevalence of suicide ideation and suicide attempts in nine countries

M. M. WEISSMAN a1c1, R. C. BLAND a1, G. J. CANINO a1, S. GREENWALD a1, H.-G. HWU a1, P. R. JOYCE a1, E. G. KARAM a1, C.-K. LEE a1, J. LELLOUCH a1, J.-P. LEPINE a1, S. C. NEWMAN a1, M. RUBIO-STIPEC a1, J. E. WELLS a1, P. J. WICKRAMARATNE a1, H.-U. WITTCHEN a1 and E.-K. YEH a1
a1 Department of Psychiatry, College of Physicians and Surgeons of Columbia University and Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico; Department of Psychiatry, National Taiwan University Hospital and Department of Psychiatry, Taipei Medical College, Taipei, Taiwan; Department of Psychological Medicine and Department of Public Health and General Practice, Christchurch School of Medicine, Christchurch, New Zealand; Department of Psychiatry and Psychology, St. George Hospital, American University of Beirut, Lebanese University, St. Joseph University and Institute for Development of Research and Applied Care, Lebanon; Keyo Psychiatric Institute, Kyongii-Do, Republic of Korea; INSERM U 169, Villejuif and Hôpital Fernand Widal, Paris, France; and Max Planck Institute for Psychiatry, Clinical Institute, Munich, Germany


Background. There are few cross-national comparisons of the rates of suicide ideation and attempts across diverse countries. Nine independently conducted epidemiological surveys using similar diagnostic assessment and criteria provided an opportunity to obtain that data.

Methods. Suicide ideation and attempts were assessed on the Diagnostic Interview Schedule in over 40000 subjects drawn from the United States, Canada, Puerto Rico, France, West Germany, Lebanon, Taiwan, Korea and New Zealand.

Results. The lifetime prevalence rates/100 for suicide ideation ranged from 2·09 (Beirut) to 18·51 (Christchurch, New Zealand). Lifetime prevalence rates/100 for suicide attempts ranged from 0·72 (Beirut) to 5·93 (Puerto Rico). Females as compared to males had only marginally higher rates of suicidal ideation in most countries, reaching a two-fold increase in Taiwan. Females as compared to males had more consistently higher rates for suicide attempts, reaching a two- to three-fold increase in most countries. Suicide ideation and attempts in most countries were associated with being currently divorced/separated as compared to currently married.

Conclusions. While the rates of suicide ideation varied widely by country, the rates of suicide attempts were more consistent across most countries. The variations were only partly explained by variation in rates of psychiatric disorders, divorce or separation among countries and are probably due to cultural features that we do not, as yet, understand.

c1 Address for correspondence: Dr Myrna M. Weissman, College of Physicians and Surgeons of Columbia University, Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY10032, USA.