An examination of DSM-IV depressive symptoms and risk for suicide completion in major depressive disorder: a psychological autopsy study.
BACKGROUND
It is unclear whether certain DSM-IV depressive symptoms are more prevalent among individuals who die in the context of a major depressive episode and those who do not, whether this is associated with proximal or distal suicide risk, and whether depressive symptoms cluster to indicate suicide risk.


METHODS
A psychological autopsy method with best informants was used to investigate DSM-IV depressive symptoms among 156 suicides who died in the context of a major depressive episode and 81 major depressive controls.


RESULTS
Suicides' depressive symptoms were more likely to include weight or appetite loss, insomnia, feelings of worthlessness or inappropriate guilt as well as recurrent thoughts of death or suicidal ideation. Fatigue and difficulties concentrating or indecisiveness were less prevalent among depressed suicides. These associations were independent of concomitant axis I and II psychopathology. The concomitant presence of (a) fatigue as well as impaired concentration or indecisiveness and (b) weight or appetite gain and hypersomnia was associated with decreased suicide risk. Inter-episode symptom concordance suggests that insomnia is an immediate indicator of suicide risk, while weight or appetite loss and feelings of worthlessness or guilt are not.


CONCLUSIONS
This study employed proxy-based interviews.


CONCLUSIONS
We found that discrete DSM-IV depressive symptoms and clusters of depressive symptoms help differentiate depressed individuals who die by suicide and those who do not. Moreover, some DSM-IV depressive symptoms are associated with an immediate risk for suicide, while others may result from an etiology of depression common to suicide without directly increasing suicide risk.
McGirr
Alexander
A
McGill Group for Suicide Studies, Douglas Hospital Research Center, McGill University, 6875 LaSalle Blvd., Montreal, QC, Canada H4H 1R3.
Renaud
Johanne
J
Seguin
Monique
M
Alda
Martin
M
Benkelfat
Chawki
C
Lesage
Alain
A
Turecki
Gustavo
G
D000328:Adult; D001066:Appetite; D001288:Attention; D001835:Body Weight; D015897:Comorbidity; D003657:Decision Making; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005221:Fatigue / Q000523:psychology; D005260:Female; D006167:Guilt; D006801:Humans; D008297:Male; D008875:Middle Aged; D010552:Personality Assessment; D011792:Quebec; D012189:Retrospective Studies; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology; D013405:Suicide / Q000523:psychology*