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The relationship of comorbidity of mental and substance use disorders with suicidal behaviors in the Nigerian Survey of Mental Health and Wellbeing

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Abstract

Background

Mental and substance use disorders are often associated with an elevated risk for suicidal behaviors. The role of the co-occurrence of multiple disorders in this association is still unclear.

Method

The Nigerian Survey of Mental Health and Wellbeing is a community survey of mental and substance use disorders as well as of suicidal outcomes. Face-to-face assessment was conducted using the World Health Organization’s Composite International Diagnostic Interview, version 3. A total of 6,752 adults, aged 18 years and over, were interviewed.

Results

Persons with lifetime suicide attempt were more likely than those without attempt to have experienced lifetime DSM-IV disorders. Lifetime attempters were also more likely to have comorbid conditions. Compared with only 0.4% of persons with no history of lifetime attempts, over 11% of persons with lifetime attempt had three or more co-occurring disorders. Multivariate analysis controlling for the effects of comorbid conditions suggests that while mood disorder is independently associated with suicidal outcomes, comorbidity partly explains the association of anxiety disorders and almost fully accounts for the association of substance use disorders with suicidal outcomes.

Conclusion

Comorbidity is an important factor in the association of mental and substance use disorders with suicidal behavior.

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Acknowledgments

Funding for the NSMHW was provided by World Health Organization, Geneva and the WHO country office in Nigeria. Collaborating investigators include O. Gureje, principal investigator; Drs R. Uwakwe, O. Udofia, A. Wakil, N. Enyidah, M. Ekpo and O. Adeyemi. The NSMHW is carried out in conjunction with the WHO World Mental Health Survey Initiative. We thank the WMH staff for assistance with instrumentation, fieldwork, and data analysis. These activities were supported by the United States National Institute of Mental Health (R01MH070884, MH077883), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01-DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, the Eli Lilly & Company Foundation, Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, and Bristol-Myers Squibb. A complete list of WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/.

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Authors and Affiliations

  1. Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Awka, Nnewi, Nigeria

    Richard Uwakwe

  2. Department of Psychiatry, University College Hospital, University of Ibadan, PMB 5116, Ibadan, Nigeria

    Oye Gureje

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  1. Richard Uwakwe
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  2. Oye Gureje
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Correspondence to Oye Gureje.

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Uwakwe, R., Gureje, O. The relationship of comorbidity of mental and substance use disorders with suicidal behaviors in the Nigerian Survey of Mental Health and Wellbeing. Soc Psychiatry Psychiatr Epidemiol 46, 173–180 (2011). https://doi.org/10.1007/s00127-009-0178-2

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  • DOI: https://doi.org/10.1007/s00127-009-0178-2

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