Suicide in Severe Depression: A Longitudinal Case-Control Study

Sammanfattning: Suicide in Severe Depression. A Longitudinal Case-Control Study. The present thesis is based on a case-control study of suicide victims with a severe depression/ melancholia. All patients admitted to the Department of Psychiatry 1956-1969 who received this diagnosis on a multiaxial schedule (1206 patients) were followed up in two sessions to 1984 and to 1998 concerning suicide and general mortality. A blind record evaluation of suicide victims with a primary depression at first follow up was performed on altogether 89 patients and 89 matched controls. Characteristics of depression did not differentiate between suicides and controls. 1. Initial ratings of heredity for psychosis or brittle/sensitive personality were related to suicide in the male group. There was a negative correlation with disharmony during childhood and physical illness in the female group. These findings indicate a vulnerability in the suicide group. 2. Suicidal ideation according to an established rating scale, the Beck’s SSI, was not related to suicide. 3. A suicide attempt was associated with an increased suicide risk in unipolar men and bipolar women. Characteristics of attempts, such as severity, method, and repetition did not discriminate between suicides and controls. However, female suicides more often started with a serious attempt, while controls showed an increase in severity. Life events were of minor importance in suicides as compared to controls. 4. Late in the course of depression (between 1984 and 1998) a sex difference appears with a higher rate in men, not seen at first follow up. 5. Controls more often received continuation treatment with antidepressants after ECT. In conclusion there was an evidence for a high degree of vulnerability in the suicide group, and a suicidal process with increasingly severe attempts could not be confirmed.