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Am J Psychiatry 1995; 152:358-364
Copyright © 1995 by American Psychiatric Association
Disproportionate suicidality in patients with comorbid major depression and alcoholism
JR Cornelius, IM Salloum, J Mezzich, MD Cornelius, H Fabrega Jr, JG Ehler, RF Ulrich, ME Thase and JJ Mann
Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213.
OBJECTIVE: The two purposes of this study were to provide a comprehensive
description of the clinical features of patients who presented to an intake
psychiatric setting with major depression and alcohol dependence and to
determine which clinical features distinguished this dual-diagnosis group
from patients with the two relevant single diagnoses. METHOD: During a
recent 5-year period, a total of 107 patients who came to a psychiatric
facility for initial evaluation were diagnosed as having both major
depression and alcohol dependence. The clinical profile of this
dual-diagnosis group was compared to that of nondepressed alcoholics (N =
497) and nonalcoholic patients with major depression (N = 5,625), assessed
at the same facility, on the basis of information from the Initial
Evaluation Form, a semistructured instrument containing a standardized
symptom inventory that includes ratings of severity. RESULTS: The
psychiatric symptom that most strongly distinguished the depressed
alcoholics from the two comparison groups was the level of suicidality. The
depressed alcoholics differed significantly from the nonalcoholic depressed
patients on only two depressive symptoms, suicidality (59% higher) and low
self-esteem (22% higher); they were also significantly distinguished from
the nonalcoholic depressed patients by factors such as greater impulsivity,
functional impairment, and abnormal personal and social history markers.
CONCLUSIONS: Suicidality was disproportionately greater than other
psychiatric symptoms in the depressed alcoholics. The clinical profile of
depressed alcoholics suggests that they suffer an additive or synergistic
effect of two separate disorders, resulting in a disproportionately high
level of acute suicidality upon initial psychiatric evaluation.
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