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Original Research

Outcome of Patients With Major Depressive Disorder After Serious Suicide Attempt

Kirsi Suominen, MD, PhD; Jari Haukka, PhD; Hanna M. Valtonen, MD, PhD; and Jouko Lönnqvist, MD, PhD

Published: October 15, 2009

Article Abstract

Objective: To investigate the outcome of subjects with major depressive disorder after serious suicide attempt and to examine the effect of psychotic symptoms on their outcome.

Method: The study population included all individuals aged 16 years or older in Finland who were hospitalized with ICD-10 diagnoses of major depressive disorder and attempted suicide from 1996 to 2003 (N‘ ‰=‘ ‰1,820). The main outcome measures were completed suicides, overall mortality, and repeated suicide attempts during drug treatment versus no treatment.

Results: During the 4-year follow-up period, 13% of patients died, 6% completed suicide, and 31% made a repeat suicide attempt. Subjects with major depression with psychotic features completed suicide more often than subjects without psychotic features during the follow-up (hazard
ratio [HR] 3.32; 95% CI, 1.95-5.67). Antidepressant treatment reduced all-cause mortality by 24% (HR 0.74; 95% CI, 0.56-0.97) but did not reduce suicide mortality (HR 1.06; 95% CI, 0.71-1.58).

Conclusions: Psychotic symptoms during major depressive episode increase the risk of completed suicide after serious suicide attempt. The quality
of treatment for major depression with psychotic features after attempted suicide should be improved to prevent suicide.

Submitted: February 7, 2009; accepted July 21, 2009.

Corresponding author: Kirsi Suominen, MD, PhD, National Institutes of Health and Welfare, Department of Mental Health and Substance Use, Mannerheimintie 166, 00300 Helsinki, Finland (

Volume: 70

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