Prospective study of risk factors for attempted suicide among patients with DSM–IV major depressive disorder

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Abstract
Background There are few prospective studies on risk factors for attempted suicide among psychiatric out- and in-patients with major depressive disorder. Aims To investigate risk factors for attempted suicide among psychiatric out- and in-patients with major depressive disorder in the city of Vantaa, Finland. Method The Vantaa Depression Study included 269 patients with DSM–IVmajor depressive disorder diagnosed using semistructured interviews and followed up at 6- and 18-month interviews with a life chart. Results During the 18-month followup, 8% of the patients attempted suicide. The relative risk of an attempt was The relative risk of an attempt was 2.50 during partial remission and 7.54 during a major depressive episode, compared with full remission ( P 0.001). Numerous factors were associated with this risk, but lacking a partner, previous suicide attempts and total time spent in major depressive episodes were the most robust predictors. Conclusions Suicide attempts among patients with major depressive disorder are strongly associated with the presence and severity of depressive symptoms and predicted by lack of partner, previous suicide attempts and time spent in depression. Reducing the time spent depressed is a credible preventive measure.