Affective disorders and suicide risk: a reexamination

Area of Science:

• Psychiatry
• Mental Health Research
• Epidemiology

Background:

• A 1970 meta-analysis estimated suicide risk in affective illness at 15%, a figure widely generalized.
• This generalized estimate has been uncritically applied to all depressive disorders in numerous publications and textbooks.
• The current study questions the generalizability and accuracy of this long-standing estimate.

Purpose of the Study:

• To re-evaluate suicide risk in patients with affective disorders.
• To propose an alternative estimate of suicide risk based on treatment setting.
• To challenge the uncritical acceptance of the 1970 Guze and Robins estimate.

Main Methods:

• A literature search identified studies with data on suicide occurrence in affective illness.
• Studies were categorized into three groups: outpatients, inpatients, and suicidal inpatients.
• Suicide risks were calculated meta-analytically for these groups and previously published collections.

Main Results:

• A hierarchy of suicide risk was observed based on treatment intensity.
• Lifetime suicide prevalence was 8.6% for patients hospitalized for suicidality.
• Lifetime suicide prevalence was 4.0% for general affective disorder inpatients, 2.2% for mixed inpatient/outpatient groups, and <0.5% for nonaffectively ill populations.

Conclusions:

• Case fatality prevalence is a more appropriate measure of suicide risk than proportionate mortality prevalence.
• While affective disorders confer higher suicide risk than the general population, specific diagnostic subtypes are not reliable predictors.
• Hospitalization, particularly for suicidality, is a significant indicator of elevated suicide risk, suggesting treatment setting intensity is a key factor.