Suicide in major depression in different treatment settings.
BACKGROUND
Whether suicide victims having suffered from major depression differ in their characteristics and treatment of depression received in various settings prior to death has been unknown.


METHODS
From a random sample representing all completed suicides in Finland within a 12-month period, cases with a best estimate diagnosis of current unipolar DSM-III-R major depression (N = 71) were comprehensively analyzed using the method of psychological autopsy. Suicide victims with major depression were classified according to treatment setting, and the victims in different settings--psychiatric care (N = 32), medical care (N = 27), and no contact with health care (N = 12)--were compared.


RESULTS
The sex distribution of suicides who had major depression was equal within psychiatric care; but in medical care or without contact with health care, 77% (30 of 39) were men (p = .018). Significantly more victims in psychiatric than in medical care had communicated to attending personnel their intent to commit suicide (59% [19 of 32] vs. 19% [5 of 27], p = .004). Antidepressants were received by 60% of victims in psychiatric care but only 16% in medical care (p = .002).


CONCLUSIONS
Suicide victims with major depression differ in sex distribution and communication of suicide intent among treatment settings, which may complicate the ability to generalize research findings, particularly from psychiatric to medical care. Promoting suicide prevention in major depressive disorders would seem to require improving not only the quality of treatment within psychiatric care, but also basic skills in recognizing and treating depression in medical care, especially for male patients.
Isometsä
E T
ET
National Public Health Institute, Department of Mental Health, Helsinki, Finland.
Aro
H M
HM
Henriksson
M M
MM
Heikkinen
M E
ME
Lönnqvist
J K
JK
D017677:Age Distribution; D000928:Antidepressive Agents / Q000627:therapeutic use; D003142:Communication; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011570:Psychiatry; D011613:Psychotherapy; D017678:Sex Distribution; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D000092864:Suicide Prevention
D000928:Antidepressive Agents