title: Feelings of worthlessness during a single complicated major depressive episode predict postremission suicide attempt.
abstract: OBJECTIVE
  To establish which symptoms of major depressive episode (MDE) predict postremission suicide attempts in complicated single-episode cases.
  
  
  METHODS
  Using the nationally representative two-wave National Epidemiologic Survey on Alcohol and Related Conditions data set, we identified wave 1 lifetime single-episode MDE cases in which the episode remitted by the beginning of the wave 2 three-year follow-up period (N = 2791). The analytic sample was further limited to 'complicated' cases (N = 1872) known to have elevated suicide attempt rates, defined as having two or more of the following: suicidal ideation, marked role impairment, feeling worthless, psychomotor retardation, and prolonged (>6 months) duration.
  
  
  RESULTS
  Logistic regression analyses showed that, after controlling for wave 1 suicide attempt which significantly predicted postremission suicide attempt (OR = 10.0), the additional complicated symptom 'feelings of worthlessness' during the wave 1 index episode significantly and very substantially predicted postremission suicide attempt (OR = 6.96). Neither wave 1 psychomotor retardation nor wave 1 suicidal ideation nor any of the other wave 1 depressive symptoms were significant predictors of wave 2 suicide attempt.
  
  
  CONCLUSIONS
  Among depressive symptoms during an MDE, feelings of worthlessness is the only significant indicator of elevated risk of suicide attempt after the episode has remitted, beyond previous suicide attempts.
authors.affiliation: Silver School of Social Work and Department of Psychiatry, School of Medicine, New York University, New York, NY, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Wakefield
authors.affiliation: School of Social Work, Temple University, Philadelphia, PA, USA.
authors.forename: M F
authors.initials: MF
authors.lastname: Schmitz
mesh_terms: D000328:Adult; D003865:Major Depressive Disorder / Q000523:psychology*; D004644:Emotions; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology*
keywords: National Epidemiologic Survey on Alcohol and Related Conditions; complicated depression; feelings of worthlessness; harmful dysfunction; major depression; major depressive episode; melancholic depression; psychomotor retardation; suicidal ideation; suicide attempt; uncomplicated depression