The Impact of Attempted Suicide on the Symptoms and Course of Mood Disorders
J Clin Psychiatry 2003;64(10):1210-1216
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Case-controlled studies have
produced conflicting results on the relief of depression
following attempted suicide. This study examined the impact of
attempted suicide on the symptoms and course of mood disorders.
Method: Of 2800 inpatients reviewed
retrospectively, 40 depressed patients who had attempted suicide
immediately before admission and 40 depressed but nonsuicidal
control patients satisfied entry criteria for the study. The
overall severity of their depression had been rated by the
treating psychiatrists before the attempted suicide or at
admission using the DSM-III-R (or DSM-IV) severity scale. The
severity of depression at 1 week after admission was evaluated by
reviewing medical records. For categorical analysis, improvement
was defined as a reduction of one or more categories on the
DSM-III-R (or DSM-IV) severity scale. We assigned scores of 1-6
to this scale to enable quantitative comparisons.
Results: Both categorical and dimensional
analyses demonstrated that depression was significantly (p <
.05) more likely to improve within 1 week of admission among
suicidal unipolar patients than among nonsuicidal unipolar
patients. Logistic regression analyses revealed that a unipolar
course was significantly (p = .023) associated with the
improvement of depression. Of the 15 patients showing
postsuicidal improvement of depression, 5 (33%) relapsed within 1
month. No significant predictors of their relapses were detected.
Of 7 patients with postsuicidal manic switching, 4 (57%)
experienced a switch-down into depression.
Conclusion: This study suggests that
unipolar depression is significantly improved after attempted
suicide, but also that depressed patients showing postsuicidal
improvement or manic switching are likely to undergo relapse or
switch-down into depression within a short period.