Inadequate treatment for major depression both before and after attempted suicide.
OBJECTIVE
The authors' goal was to investigate the treatment received by suicide attempters with major depression before and after the index attempt.


METHODS
Forty-three patients with current unipolar DSM-III-R major depression were identified in a diagnostic study from a systematic sample of suicide attempters in Helsinki. All were comprehensively interviewed and investigated after the attempt, and their treatment was ascertained from psychiatric and other health care records and follow-up interviews.


RESULTS
During the month just before the suicide attempt, seven (16%) of the patients had received antidepressants in adequate doses, seven had received weekly psychotherapy, and none had received ECT. Although almost all of the patients complied with the recommended aftercare following the suicide attempt, after 1 month only seven (17%) were receiving antidepressants in adequate doses, nine (22%) were receiving weekly psychotherapy, and none had been given ECT.


CONCLUSIONS
It seems that few suicide attempters with major depression receive adequate treatment for depression before the suicide attempt and that, despite their well-known high risk for suicide, the treatment situation is not necessarily any better after the attempt. These findings suggest that the recognition of depression and the quality of treatment received for major depression among suicide attempters should be investigated and improved to prevent suicide.
Suominen
K H
KH
Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland.
Isometsä
E T
ET
Henriksson
M M
MM
Ostamo
A I
AI
Lönnqvist
J K
JK
D000293:Adolescent; D000328:Adult; D000359:Aftercare; D000553:Ambulatory Care; D000928:Antidepressive Agents / Q000627:therapeutic use; D001294:Attitude to Health; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D004334:Drug Administration Schedule; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011613:Psychotherapy; D011787:Quality of Health Care / Q000592:standards*; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D017211:Treatment Failure
D000928:Antidepressive Agents