Clinical Predictors of Suicide in Primary Major Depressive Disorder
J Clin Psychiatry 2005;66(4):412-417
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: Follow-up studies of patients with
depressive disorders have identified only a few replicable
predictors of suicide and have not explored possible interactions
between them. The following analysis takes advantage of a large
cohort of depressed patients given detailed, structured
interviews 2 decades ago.
Method: The data set on which this analysisis
based was collected between 1976 and 1990. Research personnel
administered the Schedule for Affective Disorders and
Schizophrenia to 785 adults who had major depressive disorder
(Research Diagnostic Criteria) but who lacked other Axis I
disorders. The current analysis used the National Death Index to
determine mortality status as of 2003.
Results: One in 4 of the 134 deaths were by
suicide for an overall suicide rate of 4.2%. In comparison to the
remaining 752 patients, the 33 who died by suicide were more
likely to have been inpatients and to have had a history of
suicide attempts at the time of baseline assessment. They had
also expressed more hopelessness and had higher ratings of
suicidal tendency. The last of these variables was the most
robust by far and, when tested with other predictors in
regression analyses, was the only one to retain significance
(p < .0001). No interactions between predictors emerged. As in
an earlier, similar study, the suicidal tendency rating was
predictive of suicides that occurred after the first year of
follow-up, which suggests that suicidal tendencies comprise a
trait that persists across episodes.
Conclusion: A global rating of suicidality
appears to be the single most important predictor of eventual
suicide in patients with major depressive disorder.