title: [Suicidal risk in recurrent depression].
abstract: Recurrent depression represents a major target of suicide prevention, due to its high prevalence and its strong association to Suicidal Behaviour (SB). In France, every year, nearly 11,000 persons dye from completed suicide and 200,000 attempt suicide. It has been recently shown that the adjusted population attributable fraction of the time spent depressed for suicide attempts was 78%. Thus, suicidal risk in recurrent depression being related to severity, partial response to treatment, chronicity and recurrences, the expectancies of treatment should be elevated. The assessment of the suicidal risk should involve psychiatric comorbidities that facilitate the act, particularly alcohol misuse, and also the lack of social support. The current conceptualisation of SB allows considering them as psychiatric entities per se. Consequently, the evaluation will be focused on the specific suicidal vulnerability: personal and family history of SB, hopelessness and impulsive aggression, and childhood maltreatment. The existence of this vulnerability would help to detect very high-risk patients, in order to deliver the necessary protections. Current advances provided by the use of neuroscientific tools open the way to improve our understanding of the pathophysiology of SB. Based on this multifocal evaluation, the clinician would identify potential therapeutic targets. Indeed, the priority is first to treat adequately recurrent depression, as it is clear that too many patients do not receive such a treatment. Next steps would be related to the efforts allowing obtaining complete remission. Comorbid disorders would need specific care. This is the case for the suicidal comorbidity that may justify implementing specific treatments such as lithium or focused psychotherapies. Finally, innovative care management need to be developed, as they are likely to be helpful to provide continuously assistance to people who are suffering in order to avoid a suicidal act.
authors.affiliation: Université Montpellier, Département Hospitalo-Universitaire d'Urgences et Post-Urgences Psychiatriques, INSERM U888, CHRU Montpellier, France. p-courtet@chu-montpellier.fr
authors.forename: P
authors.initials: P
authors.lastname: Courtet
mesh_terms: D000437:Alcoholism / Q000401:mortality / Q000523:psychology; D000928:Antidepressive Agents / Q000627:therapeutic use; D019090:Case Management; D002423:Cause of Death; D003131:Combined Modality Therapy; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000401:mortality* / Q000523:psychology / Q000628:therapy; D005602:France; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use; D008403:Mass Screening; D011613:Psychotherapy; D012008:Recurrence; D012307:Risk Factors; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000523:psychology / Q000706:statistics & numerical data*; D000092864:Suicide Prevention
chemical_list: D000928:Antidepressive Agents; D016651:Lithium Carbonate