Major depression (MDD) is a risk factor for suicidal ideation (SI). However, not everyone with MDD will consider suicide, while some people without MDD will. But people with MDD are at increased risk because of the negative affect they have as a result of MDD and, more specifically, the symptom of hopelessness, which is a known predictor of SI. There are a number of other factors that can influence the risk of SI in people with MDD. To explore these risks more deeply, Madhukar H. Trivedi of the Department of Psychiatry at the University of Texas Southwestern Medical Center in Dallas, Texas recently conducted a study analyzing data from over 4,000 individuals receiving outpatient care for MDD. The goal was to compare the level of symptoms present in the participants to SI and to examine what other factors influenced SI.
Trivedi looked at sociodemographic factors, gender, and comorbidity. In particular, the study focused on anxiety disorders, including generalized anxiety (GAD), agoraphobia, social anxiety, panic, and other psychological problems including posttraumatic stress and substance misuse. The results revealed that nearly 15% of the participants reported SI, but even more startling, nearly 35% reported that they felt that life was not worth living. With reference to the other factors, Trivedi discovered that unmarried and unemployed individuals were more likely to have SI than married, employed participants. “We found that men were more likely to have SI than women,” added Trivedi. Also, previous suicide attempts increased the chances of SI. But, said Trivedi, “We found no significant association between the number of MDEs [major depressive episodes] and the likelihood of having SI.”
The biggest psychological risk factors for SI included fear, worry, rumination, anger, irritability, GAD, and agoraphobia. Although there were very weak associations between SI and some of the other psychological conditions in the study, GAD and agoraphobia each had a statistically significant impact on SI. Participants with MDD and GAD or MDD and agoraphobia were most likely to have SI and least likely to achieve remission. Overall, these results suggest that every effort should be made to help people with MDD and in particular, the additional risk factors mentioned here, to reduce symptom severity in order to decrease risk for SI.
Trivedi, Madhukar H., David W. Morris, Stephen R. Wisniewski, Andrew A. Nierenberg, Bradley N. Gaines, Benji T. Kurian, Dian Warden, Diane Stegman, Kathy Shores-Wilson, and John A. Rush. Clinical and sociodemographic characteristics associated with suicidal ideation in depressed outpatients. Canadian Journal of Psychiatry 58.2 (2013): 113-22. Print.
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