Individuals with major depressive disorder (MDD) who exhibit suicidal behavior have 2.6 times the risk of dying from any cause compared with people with MDD who do not, according to a study published this week in JAMA Psychiatry.
“[MDD] is an important risk factor of suicidal behavior, but the added burden of suicidal behavior and MDD on the patient and societal level, including all-cause mortality, is not well studied,” wrote Johan Lundberg, M.D, Ph.D., of the Karolinska Institutet in Stockholm and colleagues. “Also, the contribution of various prognostic factors for suicidal behavior has not been quantified in larger samples.”
Lundberg and colleagues used data from the Stockholm MDD Cohort, which includes all patients diagnosed with MDD in any health care setting in the Stockholm region. The data included diagnoses, history of suicidal behaviors, days worked in the past month, and overall health care utilization such as number of outpatient physician visits and inpatient bed days per month. Further, the data included the date of death but not the cause of death.
The researchers identified all diagnosed MDD episodes among people aged 18 and older between 2012 and 2017, excluding those individuals with a history of psychosis, bipolar disorder, or dementia. Individuals whose depressive episode included suicidal behavior were matched with up to five individuals who had MDD without suicidal behavior of similar age, sex, year of MDD diagnosis, and sociodemographic status.
The study sample included 145,577 people who experienced a total of 158,169 MDD episodes, 1.4% of which included records of suicidal behavior; the average time from MDD diagnosis to the first record of suicidal behavior was less than six months. The rate of death by any cause was 2.5 per 100 person-years at risk for people whose episode included suicidal behavior and 1.0 per 100 person-years at risk for episodes without suicidal behavior. Suicidal behavior during a depressive episode was also associated with higher utilization of health care resources and days of work lost.
The individuals who experienced suicidal behaviors were younger and more prone to psychiatric comorbid conditions, such as personality disorders, substance use, and anxiety at the start of their episodes compared with those who did not experience suicidal behavior during an episode. The authors noted that the incidence of somatic disorders like heart disease or diabetes was not increased in individuals with suicidal behavior, “indicating that unnatural causes, such as accidents and suicides, may have been the main contributors to the increased mortality.”
They concluded: “Our results also indicate that patients at risk for suicidal behavior can be identified at an early stage to allow for enhanced monitoring and optimized treatment with the goal of preventing suicidal behavior and reducing mortality.”
For related information, see the Psychiatric News article “Special Report: Management of Major Depression—Yesterday, Today, and Tomorrow.”
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