Suicidal Ideation and Attempts Among Psychiatric Patients With Major Depressive Disorder
J Clin Psychiatry 2003;64(9):1094-1100
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Few studies have investigated risk
factors for suicidal ideation and attempts, or possible
variations in them, among representative samples of psychiatric
patients with major depressive disorder.
Method: As part of the Vantaa Depression Study
in Vantaa, Finland, 269 patients with DSM-IV major depressive
disorder (MDD), diagnosed by interview using semistructured World
Health Organization Schedules for Clinical Assessment in
Neuropsychiatry, version 2.0, and Structured Clinical Interview
for DSM-III-R Personality Disorders, were thoroughly
investigated. Information was gathered on patients' levels of
depression, anxiety, hopelessness, perceived social support,
social and occupational functioning, and alcohol use. Suicidal
behavior was assessed by interviews, including the Scale for
Suicidal Ideation, and by information from psychiatric records.
Data were gathered from Feb. 1, 1997, to May 31, 1998.
Results: During the current MDD episode, 58% of
all patients had experienced suicidal ideation; among the 15% of
the total who had attempted suicide, almost all (95%) had also
had suicidal ideation. In nominal regression models predicting
suicidal ideation, hopelessness, alcohol dependence or abuse, low
level of social and occupational functioning, and poor perceived
social support were found to be significant (p < .05)
independent risk factors. High severity of depression and current
alcohol dependence or abuse in particular, but also younger age
and low level of social and occupational functioning, predicted
Conclusion: Suicidal ideation is prevalent and
appears to be a precondition for suicide attempts among
psychiatric patients with MDD. The risk factors for suicidal
ideation and attempts locate in several clinical and psychosocial
domains. While these risk factors largely overlap, the overall
level of psychopathology of suicide attempters is higher compared
with that in patients with ideation, and substance use disorders
and severity of depression may be of particular importance in
predicting suicide attempts.