Suicide in major depression.
OBJECTIVE
The purpose of this study was to examine a sample representing all suicide victims with current DSM-III-R major depression in Finland within 1 year in aspects relevant to suicide prevention, including comorbidity, clinical history, current treatment, suicide methods, and communication of suicide intent.


METHODS
Using the psychological autopsy method, the authors examined all 71 suicide victims with current unipolar DSM-III-R major depression, taken from a random sample of 229 subjects representing 16.4% of all suicide victims in Finland in 1 year.


RESULTS
The majority (85%) were complicated cases with comorbid diagnoses, and comorbidity varied according to the subjects' sex and age. Three-quarters had a history of psychiatric treatment, but only 45% were receiving psychiatric treatment at the time of death. Most suicide victims had received no treatment for depression. Only 3% had received antidepressants in adequate doses, 7% weekly psychotherapy, and 3% ECT. None of the 24 psychotic subjects had received adequate psychopharmacological treatment. Few (8%) had used an antidepressant overdose as a suicide method. Men had received less treatment for depression and had more commonly used violent suicide methods.


CONCLUSIONS
Although about half of the suicide victims with major depression were receiving psychiatric care at the time of death, few were receiving adequate treatment for depression. There were significant sex differences in current and previous treatment and suicide methods. For suicide prevention in major depression, it would seem crucial to improve treatment and follow-up, for males with major depression, in particular.
Isometsä
E T
ET
National Public Health Institute, Department of Mental Health, Helsinki, Finland.
Henriksson
M M
MM
Aro
H M
HM
Heikkinen
M E
ME
Kuoppasalmi
K I
KI
Lönnqvist
J K
JK
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011613:Psychotherapy; D012494:Sampling Studies; D012737:Sex Factors; D013405:Suicide / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014754:Violence; D000092864:Suicide Prevention
D000928:Antidepressive Agents