title: Psychosocial factors associated with suicidal ideation in clinical patients with depression.
abstract: BACKGROUND
  Depression is a major risk factor for suicide, but few studies have examined psychosocial risk factors for suicide in clinical patients with depression. The purpose of this study was to investigate psychosocial factors which could be associated with suicidal ideation in clinical patients with depression including: sick-leave, help-seeking behavior, and reluctance to admit mental health problems.
  
  
  METHODS
  A multi-center cross-sectional survey using self-report questionnaire was conducted at 54 outpatient psychiatric clinics in Tokyo in 2012. Adult outpatients who were diagnosed by psychiatrists as mood disorders (F30-F39) in the International Classification of Diseases-10 (ICD-10) were included in the study. Those who met the criteria for current hypomanic or manic episode were excluded from the study.
  
  
  RESULTS
  A total of 189 patients with depression participated in the survey. Multivariable logistic regression analysis showed that taking sick-leave and having sought help from family were associated with decreased odds of current suicidal ideation. Moderate or more severe depression was associated with increased odds of suicidal ideation, and reluctance to admit own mental health problem tended to increase odds of suicidal ideation.
  
  
  CONCLUSIONS
  Living status and suicidal ideation before consultation with psychiatrist were not investigated. Severity of suicidal ideation and comorbid psychiatric disorders were not assessed.
  
  
  CONCLUSIONS
  Importance of treatment of more severe depression for suicide prevention was confirmed. Industrial health staffs should consider the possibility of positive effect of taking sick-leave when they see employees with depression. Promoting help-seeking for family and reducing stigma of mental illness may be effective for suicide prevention.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan; Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Electronic address: ando-st@igakuken.or.jp.
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Ando
authors.affiliation: Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Kiyoto
authors.initials: K
authors.lastname: Kasai
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan.
authors.forename: Misato
authors.initials: M
authors.lastname: Matamura
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan.
authors.forename: Yukako
authors.initials: Y
authors.lastname: Hasegawa
authors.affiliation: Hirakawa Clinic, Asahimachi 10-13, Hachioji, Tokyo 192-0083, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hirakawa
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan.
authors.forename: Nozomu
authors.initials: N
authors.lastname: Asukai
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003717:Denial, Psychological; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D057566:Self Report; D018582:Sick Leave; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Cross-sectional studies; Depression; Help-seeking; Sick-leave; Stigma of mental illness; Suicide