Externalizing psychopathology and risk for suicide attempt: Cross-sectional and longitudinal findings from the baltimore epidemiologic catchment area study

Amber L. Hills, Tracie O. Afifi, Brian J. Cox, O. Joseph Bienvenu, Jitender Sareen

Research output: Contribution to journalArticle


The unique association between externalizing psychopathology (i.e., diagnoses of alcohol dependence, drug dependence, and antisocial personality disorder) and suicide attempts has been understudied. We sought to examine whether externalizing disorders were risk factors for later development of new onset suicide attempts. This study examined cross-sectional and longitudinal data gathered from 1920 to 4034 adult respondents from the Baltimore site of the Epidemiologic Catchment Area Survey. In cross-sectional analyses, externalizing psychopathology was significantly associated with suicide attempts, even after adjusting for sociodemographics and internalizing disorders. After controlling for demographics and internalizing disorders, at 1-year follow-up (n = 3163) baseline externalizing psychopathology was associated with new onset suicides; at 13-year follow-up (n = 1920) baseline externalizing psychopathology was not associated with new onset suicide attempts. Externalizing psychopathology appears to be an independent short-term risk factor for suicidal behavior (odds ratio [OR] = 3.00; 95% confidence interval [CI] = 1.07-8.43), but appears less powerful in predicting long-term suicide risk (OR = 0.90; 95% CI = 0.25-3.18). These findings underline the importance of assessment of suicidality among individuals presenting with externalizing disorders.

Original languageEnglish (US)
Pages (from-to)293-297
Number of pages5
JournalJournal of Nervous and Mental Disease
Issue number5
StatePublished - May 1 2009



  • Alcohol dependence
  • Antisocial personality disorder
  • Drug dependence
  • Externalizing
  • Suicide attempt

ASJC Scopus subject areas

  • Psychiatry and Mental health

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