title: Disproportionate suicidality in patients with comorbid major depression and alcoholism.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213.
authors.forename: J R
authors.initials: JR
authors.lastname: Cornelius
authors.forename: I M
authors.initials: IM
authors.lastname: Salloum
authors.forename: J
authors.initials: J
authors.lastname: Mezzich
authors.forename: M D
authors.initials: MD
authors.lastname: Cornelius
authors.forename: H
authors.initials: H
authors.lastname: Fabrega
authors.forename: J G
authors.initials: JG
authors.lastname: Ehler
authors.forename: R F
authors.initials: RF
authors.lastname: Ulrich
authors.forename: M E
authors.initials: ME
authors.lastname: Thase
authors.forename: J J
authors.initials: JJ
authors.lastname: Mann
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D003937:Diagnosis, Differential; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D007175:Impulsive Behavior / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012649:Self Concept; D012720:Severity of Illness Index; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D014754:Violence