Suicide attempts and externalizing psychopathology in a nationally representative sample

Suicide is most often associated with internalizing disorders such as depression; however, recent evidence suggests that externalizing psychopathology (substance dependence disorders, antisocial personality disorder) may have an independent relationship with suicidal behavior. The aim in the present study was to examine the relationship between lifetime suicide attempts and lifetime externalizing psychopathology in the US National Comorbidity Survey data set (n = 5877). First, hierarchical regression was performed to explore the associations between internalizing and externalizing disorders and suicide attempts. Externalizing psychopathology was significantly associated with lifetime suicide attempts (adjusted odds ratio = 3.47; P < .001) and significantly improved the model beyond that including only the sociodemographic variables and internalizing psychopathology (chi(2) difference = 73.12; df = 1; P < .001). A second logistic regression was used to investigate the association between specific patterns of psychopathology and suicidality. Externalizing disorders were significantly associated with suicide attempts even in the absence of internalizing disorders (adjusted odds ratio = 5.98; 95% confidence interval = 3.07-11.67; P < .001). These findings add to the growing literature that suggests that externalizing psychopathology is an important psychiatric correlate of suicidal behavior.