title: Suicidal ideation and attempts among psychiatric patients with major depressive disorder.
abstract: BACKGROUND
  Few studies have investigated risk factors for suicidal ideation and attempts, or possible variations in them, among representative samples of psychiatric patients with major depressive disorder.
  
  
  METHODS
  As part of the Vantaa Depression Study in Vantaa, Finland, 269 patients with DSM-IV major depressive disorder (MDD), diagnosed by interview using semistructured World Health Organization Schedules for Clinical Assessment in Neuropsychiatry, version 2.0, and Structured Clinical Interview for DSM-III-R Personality Disorders, were thoroughly investigated. Information was gathered on patients' levels of depression, anxiety, hopelessness, perceived social support, social and occupational functioning, and alcohol use. Suicidal behavior was assessed by interviews, including the Scale for Suicidal Ideation, and by information from psychiatric records. Data were gathered from Feb. 1, 1997, to May 31, 1998.
  
  
  RESULTS
  During the current MDD episode, 58% of all patients had experienced suicidal ideation; among the 15% of the total who had attempted suicide, almost all (95%) had also had suicidal ideation. In nominal regression models predicting suicidal ideation, hopelessness, alcohol dependence or abuse, low level of social and occupational functioning, and poor perceived social support were found to be significant (p < .05) independent risk factors. High severity of depression and current alcohol dependence or abuse in particular, but also younger age and low level of social and occupational functioning, predicted suicide attempt.
  
  
  CONCLUSIONS
  Suicidal ideation is prevalent and appears to be a precondition for suicide attempts among psychiatric patients with MDD. The risk factors for suicidal ideation and attempts locate in several clinical and psychosocial domains. While these risk factors largely overlap, the overall level of psychopathology of suicide attempters is higher compared with that in patients with ideation, and substance use disorders and severity of depression may be of particular importance in predicting suicide attempts.
authors: Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland.
authors: T Petteri
authors: TP
authors: Sokero
authors: Tarja K
authors: TK
authors: Melartin
authors: Heikki J
authors: HJ
authors: Rytsälä
authors: Ulla S
authors: US
authors: Leskelä
authors: Paula S
authors: PS
authors: Lestelä-Mielonen
authors: Erkki T
authors: ET
authors: Isometsä
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D008875:Middle Aged; D010552:Personality Assessment; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics; D012189:Retrospective Studies; D012307:Risk Factors; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*