Exploring the Correlates of Suicide Attempts Among Individuals With Major Depressive Disorder: Findings From the National Epidemiologic Survey on Alcohol and Related Conditions
J Clin Psychiatry 2008;69(7):1139-1149
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: There are no previous studies
describing the correlates of suicide attempts in individuals
with major depressive disorder in a nationally
representative sample. This study explores the
sociodemographic variables, mental disorders, and specific
depressive symptoms associated with suicide attempts in
Method: Data were drawn from Wave 1 of the
National Epidemiologic Survey on Alcohol and
Related Conditions (NESARC), a large (N=43,093)
nationally representative survey of mental illness in
the United States conducted between 2001 and 2002.
Persons with lifetime major depressive disorder (N=5128; diagnosed according to DSM-IV)
were categorized according to the presence (N=865)
or absence (N=4263) of a lifetime history of
suicide attempts. Multivariate logistic regression was used
to compare the 2 groups across a broad range of
sociodemographic and mental disorder correlates, as well
as to compare specific depressive symptoms associated with a history of suicide attempts. Positive
predictive values (PPVs) were calculated to evaluate
the effectiveness of each correlate in predicting
suicide attempts. Analyses were conducted separately for
men and women.
Results: Sociodemographic factors
significantly associated with a history of suicide attempts
included Hispanic or Latino ethnicity (p < .05), younger age
(p < .01), and low annual income (p < .01). A history
of suicide attempt was significantly associated with
any anxiety, personality, or substance use disorder
among both men and women (all p < .01). Personality
disorder comorbidity was most predictive of suicide
attempt. In men, suicide attempts had a strong association
with dependent personality disorder (adjusted
odds ratio [AOR] = 3.81; 95% CI = 1.14 to 12.73),
whereas in women, suicide attempts had a strong
association with antisocial personality disorder
(AOR = 2.71; 95% CI = 1.72 to 4.25). Dependent
personality disorder predicted suicide attempt in almost
three quarters of depressed men (PPV = 74.3%;
95% CI = 54.2 to 87.6). The depressive symptom most
strongly associated with a history of suicide attempts
in both men and women was feelings of worthlessness
(AOR = 5.48, 95% CI = 3.36 to 8.94 for men;
AOR = 4.93, 95% CI = 3.56 to 6.84 for women).
Conclusions: This study contributes to the
existing literature on risk factors for suicide
attempts in depressed individuals. Identifying specific
depressive symptoms and comorbid mental illnesses
may improve the clinical assessment of suicide risk in
people with major depressive disorder.