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Am J Psychiatry 1994; 151:530-536
Copyright © 1994 by American Psychiatric Association
Suicide in major depression
ET Isometsa, MM Henriksson, HM Aro, ME Heikkinen, KI Kuoppasalmi and JK Lonnqvist
National Public Health Institute, Department of Mental Health, Helsinki, Finland.
OBJECTIVE: The purpose of this study was to examine a sample representing
all suicide victims with current DSM-III-R major depression in Finland
within 1 year in aspects relevant to suicide prevention, including
comorbidity, clinical history, current treatment, suicide methods, and
communication of suicide intent. METHOD: Using the psychological autopsy
method, the authors examined all 71 suicide victims with current unipolar
DSM-III-R major depression, taken from a random sample of 229 subjects
representing 16.4% of all suicide victims in Finland in 1 year. RESULTS:
The majority (85%) were complicated cases with comorbid diagnoses, and
comorbidity varied according to the subjects' sex and age. Three-quarters
had a history of psychiatric treatment, but only 45% were receiving
psychiatric treatment at the time of death. Most suicide victims had
received no treatment for depression. Only 3% had received antidepressants
in adequate doses, 7% weekly psychotherapy, and 3% ECT. None of the 24
psychotic subjects had received adequate psychopharmacological treatment.
Few (8%) had used an antidepressant overdose as a suicide method. Men had
received less treatment for depression and had more commonly used violent
suicide methods. CONCLUSIONS: Although about half of the suicide victims
with major depression were receiving psychiatric care at the time of death,
few were receiving adequate treatment for depression. There were
significant sex differences in current and previous treatment and suicide
methods. For suicide prevention in major depression, it would seem crucial
to improve treatment and follow-up, for males with major depression, in
particular.
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