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War and first onset of suicidality: the role of mental disorders

Published online by Cambridge University Press:  28 February 2012

E. G. Karam ,
M. M. Salamoun ,
Z. N. Mneimneh ,
J. A. Fayyad ,
A. N. Karam ,
R. Hajjar ,
H. Dimassi ,
M. K. Nock  and
R. C. Kessler
E. G. Karam*
Affiliation:
Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University Medical School, Beirut, Lebanon Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
M. M. Salamoun
Affiliation:
Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Z. N. Mneimneh
Affiliation:
Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon Survey Methodology Program, Survey Research Operation, Institute for Social Research, University of Michigan, MI, USA
J. A. Fayyad
Affiliation:
Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University Medical School, Beirut, Lebanon Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
A. N. Karam
Affiliation:
Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University Medical School, Beirut, Lebanon Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
R. Hajjar
Affiliation:
Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
H. Dimassi
Affiliation:
Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon School of Pharmacy, Lebanese American University, Lebanon
M. K. Nock
Affiliation:
Department of Psychology, Harvard University, Cambridge, MA, USA
R. C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
*
*Address for correspondence: E. G. Karam, M.D., IDRAAC, PO Box 166227, Ashrafieh, Lebanon1100 2110. (Email: [email protected])
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Abstract

Background

Suicide rates increase following periods of war; however, the mechanism through which this occurs is not known. The aim of this paper is to shed some light on the associations of war exposure, mental disorders, and subsequent suicidal behavior.

Method

A national sample of Lebanese adults was administered the Composite International Diagnostic Interview to collect data on lifetime prevalence and age of onset of suicide ideation, plan, and attempt, and mental disorders, in addition to information about exposure to stressors associated with the 1975–1989 Lebanon war.

Results

The onset of suicide ideation, plan, and attempt was associated with female gender, younger age, post-war period, major depression, impulse-control disorders, and social phobia. The effect of post-war period on each type of suicide outcome was largely explained by the post-war onset of mental disorders. Finally, the conjunction of having a prior impulse-control disorder and either being a civilian in a terror region or witnessing war-related stressors was associated with especially high risk of suicide attempt.

Conclusions

The association of war with increased risk of suicidality appears to be partially explained by the emergence of mental disorders in the context of war. Exposure to war may exacerbate disinhibition among those who have prior impulse-control disorders, thus magnifying the association of mental disorders with suicidality.

Keywords

Mental disorderssuicidewar
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 10 , October 2012 , pp. 2109 - 2118
Copyright
Copyright © Cambridge University Press 2012

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