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The Impact of Attempted Suicide on the Symptoms and Course of Mood Disorders

J Clin Psychiatry 2003;64:1210-1216

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.