title: Clinical correlates of planned, more lethal suicide attempts in major depressive disorder.
abstract: BACKGROUND
  Assessment of suicide plans is standard in acute psychiatric care, but there is a limited evidence base to guide this routine clinical practice. The purpose of this study was to investigate clinical correlates of suicide planning in depressed patients.
  
  
  METHODS
  151 patients with major depressive disorder and a lifetime history of suicide attempt were studied. Subjects received a comprehensive evaluation including structured diagnostic interview for Axis I and II disorders, current symptoms, impulsivity, and systematic assessment of suicide planning prior to the most recent suicide attempt.
  
  
  RESULTS
  Seriousness of suicide attempt planning correlated with lethality of suicidal acts. Comorbid anxiety disorder and anxiety correlated with less suicide planning. Specifically, this negative correlation was with comorbid panic disorder. Planning did not correlate with severity of depression or aggressive/impulsive traits.
  
  
  CONCLUSIONS
  Cross-sectional design, retrospective recall of suicide planning data, limited applicability to completed suicide or other psychiatric disorders.
  
  
  CONCLUSIONS
  In major depression, comorbid panic disorder appears protective against more carefully planned, higher lethality suicide attempts. Surprisingly, severity of depression and aggressive impulsive traits do not predict planning or lethality of suicide attempts. We have previously reported that anxiety severity protects against the probability of a suicide attempt and now extend that observation to show there is protection against lethality of a suicide attempt. Treatment of anxiety without directly treating major depression may place patients at greater risk of suicidal behavior.
authors.affiliation: Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY 10032, USA.
authors.forename: Atsuo
authors.initials: A
authors.lastname: Nakagawa
authors.forename: Michael F
authors.initials: MF
authors.lastname: Grunebaum
authors.forename: Maria A
authors.initials: MA
authors.lastname: Oquendo
authors.forename: Ainsley K
authors.initials: AK
authors.lastname: Burke
authors.forename: Haruo
authors.initials: H
authors.lastname: Kashima
authors.forename: J John
authors.initials: JJ
authors.lastname: Mann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D033182:Intention; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D010555:Personality Inventory / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*