Does the outcome of a first pregnancy predict depression, suicidal ideation, or lower self-esteem? Data from the National Comorbidity Survey

This study examines the risk of depression, suicidal ideation, and lower self-esteem following an abortion versus a delivery, with and without adjusting for important correlates. Using the National Comorbidity Survey, we tested how first pregnancy outcome (abortion vs. delivery) related to subsequent major depression, suicidal ideation, and self-esteem. Models controlling for risk factors, such as background and economic factors, prepregnancy violence experience, and prepregnancy mental health, as well as a model with all risk factors, were examined. When no risk factors were entered in the model, women who had abortions were more likely to have subsequent depression, OR=1.53, 95% CI [1.05-2.22], and suicidal ideation, OR=2.02, 95% CI [1.40-2.92], but they were not more likely to have lower self-esteem, B=-.02. When all risk factors were entered, pregnancy outcome was not significantly related to later depression, OR=0.87, 95% CI [0.54-1.37], and suicidal ideation, OR=1.19, 95% CI [0.70-2.02]. Predictors of mental health following abortion and delivery included prepregnancy depression, suicidal ideation, and sexual violence. Policies and practices implemented in response to the claim that abortion hurts women are not supported by our findings. Efforts to support women's mental health should focus on known risk factors, such as gender-based violence and prior mental health problems, rather than abortion history.     

Exploring potential associations of suicidal ideation and ideas of self‐harm in patients with congestive heart failure

Objective: To determine the factors, which are associated with suicidal ideation and ideas of self‐harm in patients with congestive heart failure (CHF). Methods: We examined 294 patients with documented CHF, New York Heart Association (NYHA) functional class II‐IV, in a cross sectional study at three cardiac outpatient departments. Measures included self‐reports of suicidal ideation and self‐harm (PHQ‐9), depression (SCID), health‐related quality of life (SF‐36), multimorbidity (CIRS‐G), consumption of alcoholic beverages, as well as comprehensive clinical status. Data were analyzed using logistic regression analyses. Results: 50 patients (17.1%) reported experiencing suicidal ideation and/or ideas of self‐harm on at least several days over the past two weeks. The final regression model revealed significant associations with health‐related quality of life, physical component (odds ratio [OR] 0.56; 95% confidence interval [CI]: 0.35–0.91), and mental component (OR 0.50; 95% CI: 0.31–0.82), consumption of alcoholic beverages (OR 1.27; 95% CI: 1.05–1.54), first‐episode depression (OR 3.92; 95% CI: 1.16–13.22), and lifetime depression (OR 10.89; 95% CI: 2.49–47.72). Age was only significant in the univariable (P=.03) regression analysis. NYHA functional class, left ventricular ejection fraction (LVEF), etiology of CHF, medication, cardiovascular interventions, multimorbidity, gender, and living situation were not significantly associated with suicidal ideation or ideas of self‐harm. Conclusions: Lifetime depression, in particular, increases the risk of suicidal ideation and ideas of self‐harm in CHF patients. Furthermore, the findings of our study underline the necessity of differentiating between first‐episode and lifetime depression in CHF‐patients in future research and clinical practice. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

What is the association between traumatic life events and alcohol abuse/dependence in people with and without PTSD? Findings from a nationally representative sample

Background: Approximately 60–90% of the general population will experience a traumatic event during their lifetime. However, relatively few will develop a trauma‐related psychological disorder. Possible psychological sequelae of trauma include posttraumatic stress disorder (PTSD) and alcohol‐use disorders (AUDs). While AUDs often occur in the context of PTSD, little is known about the degree to which AUDs are attributable to specific traumatic events. The purpose of the present investigation was to assess the degree to which specific traumatic events are predictive of AUDs in people with and without PTSD. Methods: The current sample was selected from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC; N = 34,160), a nationally representative sample of American adults. Multiple logistic regressions were performed to examine odds ratios of 27 traumatic events among individuals with and without PTSD in the prediction of AUD diagnoses. Results: Results indicated significant positive odds ratios among individuals meeting criteria for PTSD and having experienced a childhood trauma (OR = 1.40 [95% CI: 1.08–1.83], P<.01) or assaultive violence (OR = 1.41 [95% CI: 1.13–1.77], P<.01) for predicting AUDs. Also, among individuals without PTSD, childhood trauma (OR = 1.32 [95% CI: 1.23–1.41], P<.001), assaultive violence (OR = 1.42 [95% CI: 1.13–1.78], P<.001), unexpected death (OR = 1.19 [95% CI: 1.12–1.28], P<.001), and learning of trauma (OR = 1.22 [95% CI: 1.13–1.30], P<.001) positively predicted the presence of AUDs. Conclusions: Results indicate significant positive relationships between traumatic events and AUDs, particularly among individuals without PTSD. Specific associations and theoretical implications will be discussed. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Mental disorders and risk of suicide attempt in prisoners

Background

Mental disorders are overrepresented in prisoners, placing them at an increased risk of suicide. Advancing our understanding of how different mental disorders relate to distinct stages of the suicidal process—the transition from ideation to action—would provide valuable information for clinical risk assessment in this high-risk population.

Methods

Data were drawn from a representative sample of 1212 adults (1093 men) incarcerated across 13 New Zealand prisons, accounting for 14% of the national prison population. Guided by an ideation-to-action framework, three mutually exclusive groups of participants were compared on the presence of mental disorders assessed by validated DSM-IV diagnostic criteria: prisoners without any suicidal history (controls; n = 778), prisoners who thought about suicide but never made a suicide attempt (ideators; n = 187), and prisoners who experienced suicidal ideation and acted on such thoughts (attempters; n = 247).

Results

One-third (34.6%) of participants reported a lifetime history of suicidal ideation, of whom 55.6% attempted suicide at some point (19.2% of all prisoners). Suicidal outcomes in the absence of mental disorders were rare. Whilst each disorder increased the odds of suicidal ideation (OR range 1.73–4.13) and suicide attempt (OR range 1.82–4.05) in the total sample (n = 1212), only a select subset of disorders was associated with suicide attempt among those with suicidal ideation (n = 434). Drug dependence (OR 1.65, 95% CI 1.10–2.48), alcohol dependence (OR 1.89, 95% CI 1.26–2.85), and posttraumatic stress disorder (OR 2.09, 95% CI 1.37–3.17) distinguished attempters from ideators.

Conclusion

Consistent with many epidemiological studies in the general population, our data suggest that most mental disorders are best conceptualized as risk factors for suicidal ideation rather than for suicide attempt. Once prisoners consider suicide, other biopsychosocial factors beyond the mere presence of mental disorders may account for the progression from thoughts to acts of suicide.

     

Suicidal ideation and suicide attempts among diabetes mellitus: The Korea National Health and Nutrition Examination Survey (KNHANES IV,V) from 2007 to 2012

ObjectiveThe present study evaluated the mental health of patients with diabetes mellitus (DM) in Korea and compared it with mental health in the general Korean population.MethodsAll data included in the final analyses were collected from 34,065 subjects (20 years of age or older) who participated in the 2007–2012 Korea National Health and Nutrition Examination Survey (KNHANES). The mental health of 3846 DM patients were compared with that of 30,219 controls.ResultsA depressed mood for 2 or more continuous weeks was reported by 13.6% of subjects with normal glucose tolerance (NGT), 14.3% of those with impaired glucose intolerance (IFG), and 17.6% of DM patients. Suicidal thoughts were reported by 15.3% of individuals with NGT, 15.6% of participants with IFG, and 17.6% of DM patients. Suicidal attempts were reported by 0.8% of people with NGT, 1.0% of those with IFG, and 1.3% of DM patients. In DM patients, the crude odds ratio (OR) for depressive mood was 1.376 (95% confidence interval [CI]: 1.258–1.504), the OR for suicidal ideation was 1.481 (95% CI: 1.361–1.611) and the OR for suicidal attempts was 1.413 (95% CI: 1.021–1.956). A multivariate analysis revealed that the ORs for depression, suicidal ideation, and suicidal attempts in DM patients were 1.178 (95% CI: 1.070–1.297), 1.152 (95% CI: 1.050–1.263), and 1.413 (95% CI: 1.021–1.956), respectively.ConclusionsThe present study found that DM was associated with a marked increase in suicidal behaviors.     

Associations between traumatic events and suicidal behavior in South Africa

Research conducted predominantly in the developed world suggests that there is an association between trauma exposure and suicidal behavior. However, there are limited data available investigating whether specific traumas are uniquely predictive of suicidal behavior or the extent to which traumatic events predict the progression from suicide ideation to plans and attempts. A national survey was conducted with 4351 adult South Africans between 2002 and 2004 as part of the World Health Organization World Mental Health Surveys. Data on trauma exposure and subsequent suicidal behavior were collected. Bivariate and multivariate survival models tested the relationship between the type and number of traumatic events and lifetime suicidal behavior. A range of traumatic events are associated with lifetime suicide ideation and attempt; however, after controlling for all traumatic events in a multivariate model, only sexual violence (odds ratio = 4.7; confidence interval, 2.3 to 9.4) and having witnessed violence (odds ratio = 1.8; confidence interval, 1.1 to 2.9) remained significant predictors of lifetime suicide attempts. The disaggregation of the associations between traumatic events and suicide attempts indicates that they are largely caused by traumatic events predicting suicide ideation rather than by the progression from suicide ideation to attempt. This article highlights the importance of traumatic life events in the occurrence of suicidal thoughts and behaviors and provides important information about the nature of this association. Future research is needed to better understand how and why such experiences increase the risk of suicidal outcomes.     

Social support and suicidal ideation in Japan: are home visits by commissioned welfare volunteers associated with a lower risk of suicidal ideation among elderly people in the community?

Aims

Social support has consistently been reported to be effective in reducing suicidal ideation. This cross-sectional study was performed to determine whether home visits by commissioned welfare volunteers (i.e., organizations of community residents appointed by national or prefectural governments) are associated with a lower risk of suicidal ideation among the elderly.

Methods

In August 2010, questionnaires were sent to all residents aged ≥65 years in three municipalities (n = 21,232) in Okayama prefecture, Japan, and 13,929 returned the questionnaire (response rate: 65.6 %). We finally analyzed 11,218 subjects. Both home visits by commissioned welfare volunteers and suicidal ideation within the last 30 days were assessed in the questionnaire. Odds ratios (ORs) and 95 % confidence intervals (CIs) for suicidal ideation were calculated adjusting for age, sex, educational attainment, and marital status. We then additionally adjusted for instrumental and emotional support, separately.

Results

The prevalence of suicidal ideation was 10.0 % and higher in women than in men (11.4 % vs. 8.0 %). Home visits were significantly associated with a lower risk of suicidal ideation after adjusting for instrumental and emotional support, respectively (OR: 0.60, 95 % CI: 0.53–0.69; OR: 0.67, 95 % CI: 0.59–0.78). In sex-stratified analysis, the association was clearer for women than for men: the corresponding ORs among women were 0.55 (95 % CI: 0.46–0.65) and 0.61 (95 % CI: 0.52–0.73), whereas they were 0.71 (95 % CI: 0.56–0.90) and 0.78 (95 % CI: 0.61–0.99) among men.

Conclusion

Our findings suggest that home visits by commissioned welfare volunteers are significantly associated with lower suicidal ideation among the elderly, particularly in women.     

Prevalence of psychological distress,depression and suicidal ideation in an indigenous population in Panamá

Objective

The aim of this study was to investigate the prevalence of serious psychological distress (SPD), depression, and suicidal ideation in an adult Indigenous population in Panamá.

Methods

Data were collected from 211 Kuna adults using a paper-based survey. Depression and suicidal ideation were measured using the Patient Health Questionnaire (PHQ-9), and SPD was measured using the Kessler-6. Univariate analyses were used to describe demographic variables, followed by chi² tests to compare differences in demographic variables for each of the mental health outcomes (depression, serious psychological distress, suicidal ideation). A regression model, adjusted for all demographic variables, was then run for each mental health outcome to understand independent correlates.

Results

Within the sample surveyed, 6.2% (95% CI 3.4–10.4) reported serious psychological distress, 32.0% (95% CI 25.7–38.9) reported depression, and 22.9% (95% CI 17.4–29.1) reported suicidal ideation. Significant demographic differences existed with 14% of individuals between the age of 60–90 and 17% of individuals with no education reporting SPD. Women were nearly 5 times more likely to report depression than men (OR 4.90, 95% CI 1.27–19.00) and those with higher incomes were less likely to report depression (OR 0.32, 95% CI 0.13–0.78).

Conclusion

High levels of depression, SPD, and suicidal ideation were present in an Indigenous Kuna community in Panamá. Women and individuals with low income were more likely to report depression, and SPD was more common in older individuals and those with low levels of education. Suicidal ideation was high across all demographic factors, suggesting that a community-wide program to address suicide may be warranted.

     

Clinical determinants of suicidal ideation and behavior in geriatric depression

BACKGROUND: The aim of this study was to find clinical characteristics that can identify elderly patients with depression at risk for suicidal ideation and to determine their prognosis. METHOD: Suicidal ideation, past suicidal behavior, severity of depression, cognitive impairment, medical burden, disability, and social support were studied in 354 patients with depression aged 61 to 93 years. The patients had in-person evaluations every 6 months and telephone evaluations for a mean of 1.8 years (SD, 2.2). RESULTS: During the index episode, suicidal ideation was predicted by previous suicide attempts with serious intent (odds ratio [OR], 2.82; 95% confidence interval [CI], 1.37-5.80), severity of depression (OR, 1.09; 95% CI, 1.03-1.16), and poor social support (OR, 1.77; 95% CI, 1.18-2.65). Suicide attempts during the year prior to entry were reported by patients with a severe index episode (OR, 1.05; 95% CI, 1.00-1.11), impaired instrumental activities of daily living (OR, 0.78; 95% CI, 0.67-0.93), and limited impairment in activities of daily living (OR, 1.53; 95% CI, 1.10-2.14). At the initial evaluation, severity of depression, previous attempts, and seriousness of suicidal intent during previous attempts predicted the course of suicidal ideation (concordance correlation, 0.78). During follow-up, contemporaneous severity of depression was the most important determinant of suicidal ideation over time (concordance correlation, 0.88). CONCLUSIONS: Elderly individuals with severe depression, history of suicide attempts with serious intent, and poor social support are most likely to have suicidal ideation and should be targeted for appropriate interventions. Severity of depression is the strongest predictor of the course of suicidal ideation.     

Effectiveness of Cognitive Behavioral Therapy for Veterans with Depression and Suicidal Ideation

The current study examined suicidal ideation (SI) and depression outcomes among Veterans receiving Cognitive Behavioral Therapy for depression (CBT–D) throughout the Department of Veterans Affairs health care system. Patient outcomes included Beck Depression Inventory–II total score and SI item. Of 902 patients, 427 (47%) had no SI, 405 (45%) had SI but no suicidal intent, 26 (3%) indicated suicidal desire, 8 (1%) indicated suicide intent if they had the chance, and 36 (4%) did not answer this question at session one. The odds of SI decreased by 64% from 1.03 at session one to 0.37 at final assessment (OR = 0.36; 95% CI: 0.31, 0.43). Findings reveal that CBT–D was associated with significant decreases in SI and depression among Veterans.     

Mild cognitive impairment is associated with passive suicidal ideation in older adults: A population-based study

Objective

To investigate the association between MCI and passive/active suicidal ideation in a population-based sample of older adults.

Method

The sample included 916 participants without dementia acquired from the two population-based studies Prospective Population Study of Women (PPSW) and the H70-study. Cognitive status was assessed using a comprehensive neuropsychiatric examination and classified according to the Winblad et al. criteria: 182 participants were classified as cognitively intact, 448 had cognitive impairment but did not fulfill MCI criteria and 286 were diagnosed with MCI. Passive/active suicidal ideation was assessed using the Paykel questions.

Results

Passive or active suicidal ideation (any level) was reported by 16.0% of those with MCI and 1.1% of those who were cognitively intact. MCI was associated with past year life-weariness (OR 18.32, 95% CI 2.44–137.75) and death wishes (OR 5.30, 95% CI 1.19–23.64) in regression models adjusted for covariates including major depression. Lifetime suicidal ideation was reported more frequently in MCI (35.7%) than in cognitively intact participants (14.8%). MCI was associated with lifetime life-weariness (OR 2.90, 95% CI 1.67–5.05). Among individuals with MCI, impairments in memory and visuospatial ability were associated with both past year and lifetime life-weariness.

Conclusion

Our findings suggest reports of past year as well as lifetime passive suicidal ideation to be more frequent among individuals with MCI compared to those cognitively intact, indicating that individuals with MCI may constitute a high-risk group for suicidal behavior.     

Suicidal behaviors in depressed men with a family history of suicide: Effects of psychosocial factors and age

Effects of impaired social support and stressful life events on non-lethal suicidal behaviors were examined in a clinical sample of high-risk patients: depressed adult men with a family history of suicide or attempted suicide. All subjects (N = 79) were participants in the Mental Health Clinical Research Center (MHCRC) for the Study of Depression in Later Life (Duke University, USA). Outcome measures were self-reported one-year histories of three suicide-related ideation symptoms and attempted suicide. One-year prevalences for these outcomes were: death ideation, 58%; death wish, 48%; suicidal ideation, 57%; and attempted suicide, 11%. In adjusted models, none of the four measures of social support (network size, frequency of social interaction, receipt of instrumental support, and subjective social support) increased the odds of any outcome. Thus, in this high-risk group, impaired social support did not appear to increase the odds of one-year history of any form of suicide-related ideation or of attempted suicide. The number of negative life events experienced during the year before the study interview was not associated with increased odds of any ideation symptom, but was marginally higher in men who had attempted suicide during that year. Older age was significantly protective against explicit suicidal ideation (OR 0.95, CI 0.91-0.99) in this sample, but did not affect the odds of attempted suicide.     

Prevalence of and risk factors for suicide-related outcomes in the World Health Organization World Mental Health Surveys Japan

Aim:  Suicide is a major public health concern in Japan but little is known about the prevalence of and risk factors for suicidal ideation, plans, and attempts. The aim of the present study was to clarify the prevalence of and risk factors for important suicide-related outcomes.
Methods:  Important suicide-related outcomes and risk factors were assessed in face-to-face interviews with 2436 adult respondents in seven areas as part of the World Health Organization (WHO) World Mental Health Survey Initiative. Mental disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI).
Results:   The lifetime prevalence estimates of suicidal ideation, plans, and attempts were 10.9%, 2.1%, and 1.9%, respectively. Risk of suicide plans and attempts was highest when suicidal ideation occurred at an early age and within the first year of ideation. In middle-aged individuals, the period after first employment and the presence of mental disorders were risk factors.
Conclusions:  Risk of suicide plans and attempts is highest when suicidal ideation occurred at an earlier age and within the first year of ideation. Mental disorders are as predictive of the suicide-related outcomes examined here, and comorbidity is an important predictor.     

Suicidal and death ideation in Parkinson's disease

Parkinson's disease (PD) is a chronic, disabling illness affecting primarily the elderly and is associated with a high prevalence of depression. Although these are known risk factors for suicidal and death ideation, little is known about the prevalence and correlates of such ideation in PD. A convenience sample of 116 outpatients with idiopathic PD at two movement disorders centers were administered a modified Paykel Scale for suicidal and death ideation, as well as an extensive psychiatric, neuropsychological, and neurological battery. Univariate and multivariate logistic regression models were used to determine the correlates of suicidal or death ideation. Current death ideation (28%) or suicide ideation (11%) were present in 30% of the sample, and 4% had a lifetime suicide attempt. On univariate logistic regression analysis, increasing severity of depression (odds ratio = 2.92, 95% CI 2.01–4.24, P < 0.001), impulse control disorder (ICD) behaviors sometime during PD (odds ratio = 6.08, 95% CI 1.90–19.49, P = 0.002), and psychosis (odds ratio = 2.45, 95% CI 1.05–5.69, P = 0.04) were associated with either ideation. On multivariate logistic regression analysis, only increasing severity of depressive symptoms (odds ratio = 2.76, 95% CI 1.88–4.07, P < 0.001) predicted suicidal or death ideation. In conclusion, active suicidal or death ideation occurs in up to one‐third of PD patients. Comorbid psychiatric disorders, more than PD‐related disease variables, are associated with this ideation, highlighting the need for a comprehensive approach to the clinical care of PD patients. © 2008 Movement Disorder Society     

Risk factors for suicidal ideation in psychiatric patients

Sociodemographic and clinical risk factors for suicidal ideation have been less studied than risk factors for parasuicide and suicide. No reports on associations between therapy satisfaction and suicidal ideation among psychiatric patients have been published. In this study we compared a group of patients with suicidal ideation (n= 84) with a randomly selected group of nonsuicidal patients (n = 166) in community-based psychiatric services. Patients with suicidal ideation felt a need for psychiatric treatment more often than nonsuicidal patients. They were also more likely to receive antidepressive medication, and weekly therapy sessions were more common among them. A wish to change therapist (OR 15.6, 95% CI 3.6–67.8), hopeless future orientation (OR 14.8, 95% CI 4.5–48.9), severe depression as evaluated by the Beck Depression Inventory (OR 14.0, 95% CI 4.3–45.2) and dysthymia (OR 12.8, 95% CI 1.7–97.3) were the factors most strongly associated with suicidal ideation in multivariate analysis. A wish to change therapist is an expression of therapy dissatisfaction, which may therefore be among the factors most strongly associated with suicidal ideation in psychiatric patients. To help prevent suicidality among psychiatric patients special attention to therapy factors is needed. Accepted: 15 September 1997     

Are factors associated with suicidal ideation true risk factors?

Background  Adverse life events or the commencement of adverse lifestyles associate with suicidal ideation, but most associations only have been identified in cross-sectional studies. More information is needed about whether they are true risk factors and independently predict the development of suicidal ideation. Method  A sample of the general population from Eastern Finland (n = 1,339) was followed-up for three-years with baseline and two follow-up assessments using postal questionnaires. The main adverse life events and changes in lifestyles were screened at baseline and on one- and three-year follow-up. The Beck Depression Inventory was used to assess the level of depression and the presence of suicidal ideation. Results  Suicidal ideation was common in the sample (annual incidence 4.3%). At baseline it associated with a cluster of adverse life events and lifestyles, as well as depression. Nevertheless, only the Beck Depression Inventory score on 3-year follow-up (OR 1.33, 95% CI 1.22–1.45) and the onset of daily smoking during the follow-up period (OR 5.38, 95% CI 1.41–20.62) independently predicted the presence of suicidal ideation on 3-year follow-up among those who had been non-suicidal at baseline and on 1-year follow-up. Conclusion  Depressive mood appears to be a necessary precondition for the occurrence of suicidal ideation even after adverse life events.     

Association of recent gay‐related stressful events and emotional distress with suicidal behaviors over 12 months in Chinese men who have sex with men

Introduction

The study was designed to assess the association of gay‐related stressful events (GRSEs) and emotional distress with suicidal behaviors over a 12‐month period in Chinese men who have sex with men (MSM).

Methods

A total of 807 MSM were recruited using a respondent‐driven sampling method from 4 cities in northeastern China. The GRSEs were measured using the Gay‐related Stressful Life Events Scale, depression using the Self‐rating Depression Scale, and anxiety using the Self‐rating Anxiety Scale.

Results

A total of 26.0% of study participants experienced GRSEs during the 3 months, and their average Self‐rating Depression Scale and Self‐rating Anxiety Scale scores were significantly lower than the national norms. Over a 12‐month period, the prevalence of suicidal ideation, plan, and attempt was 9.7%, 4.0%, and 3.0%, respectively, each of which is at least 3 to 4 times greater than that of male adults in the general population of China. Multiple logistic regression analysis showed that GRSEs significantly increased the risk of suicidal ideation (odds ratio [OR] = 2.3, 95% confidence interval [CI], 1.4‐3.7) and plan (OR = 2.8, 95% CI, 1.3‐6.0). Depressive symptoms significantly increased the risk of suicidal ideation (OR = 3.5, 95% CI, 2.1‐5.8), plan (OR = 4.4, 95% CI, 2.0‐9.6), and attempt (OR = 5.6, 95% CI, 21.94.8). Anxiety symptoms (OR = 3.4, 95% CI, 1.4‐8.4) and cohabitation with a same sex partner (OR = 3.0, 95% CI, 1.2‐7.9) significantly increased the risk of suicide attempt.

Discussion

More efforts to reduce GRSE are worth investigating as a strategy to reduce suicidal thoughts and behaviors in Chinese MSM.     

Suicidal ideation in a random community sample: attributable risk due to depression and psychosocial and traumatic events

OBJECTIVE: To determine the attributable risk for suicidal ideation of depression and psychosocial and traumatic events in a random and representative population. METHOD: Data were gathered from a random and representative sample of 2501 South Australians. Suicidal ideation and clinical depression were determined by the general health questionnaire (GHQ-28) and the short-form health survey (SF-12) respectively, and information regarding psychosocial stressors and traumatic events was collated. These data were subjected to univariate and multivariate analyses to determine the population-attributable risks for suicidal ideation. RESULTS: Overall, 5.6% of men and 5.3% of women had suicidal ideation. Univariate analyses demonstrated a significant attributable risk for suicidal ideation for depression and the majority of the psychosocial and traumatic events. Multivariate analysis demonstrated that clinical depression remained significantly associated with suicidal ideation, with a population-attributable risk of 46.9%. Because of the small number of people in the population who experience both suicidal ideation and specific events, multivariate analysis could not be applied to individual events. However, even when the psychosocial events were summed, they no longer remained significantly associated with suicidal ideation, whereas the summation of traumatic events remained significant, with a population-attributable risk of 38.0%. CONCLUSIONS: These results confirm the importance of traumatic events as significant factors in contributing to suicidal ideation. However, of even greater importance is that they indicate, unequivocally, the magnitude of the contribution of clinical depression to suicidal ideation, with the population-attributable risk of depression indicating that elimination of mood disorders would reduce suicidal ideation by up to 46.9%.