Absence of treatment-seeking behavior, severity of depressive illness, and severity of comorbidities, respectively, could predict suicide attempts, according to a study of high-risk individuals with major depressive episodes (MDE) published in the Journal of Clinical Psychiatry. No sociodemographic characteristics examined in the study independently predicted the risk for suicide attempt.

Researchers used a comprehensive model of the 3-year risk for suicide attempt in individuals with MDE using data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC; Wave 1, 2001 to 2002; Wave 2, 2004 to 2005). Effects of 4 major clinical factors (severity of depressive illness, treatment-seeking behavior, severity of psychiatric and other physical comorbidities, and sociodemographic characteristics) were examined simultaneously using structural equation modeling.

The examination found that 3.5% of individuals with MDE (n=2587) attempted suicide over a 3-year follow-up period. An absence of treatment-seeking behavior for depression, severity of depression, and severity of comorbidities at baseline independently predicted suicide attempts between the 2 waves; 29.3% of depressed individuals who attempted suicide did not seek help for depression.

The authors found that the association between suicidal ideation and attempt from their report was consistent with prior studies and might be stronger in the short term than in the long term. In addition, passive suicidal thoughts might also be an important clinical marker of suicidal risk, at the same level of suicidal ideation, suggesting that clinicians actively inquire about this information to assess treatment options and identify individuals for preventive action.

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Risk of attempted suicide in relation to comorbid psychiatric disorders occurred only through the general psychopathology factor, highlighting the importance of diagnosing and treating other psychiatric comorbidities.

Clinicians assessing individuals with MDE are urged to inquire about prior suicide attempts, recurrent thoughts of death, quality of life, and the severity of depressive symptomatology, and are also prompted to consider the number and severity of Axis I and Axis II comorbidities to evaluate the risk for future suicide attempts. The study also showed that seeking treatment for depression had a strong protective effect against risk of suicide attempt.

Disclosures: This study was supported by National Institutes of Health. Several authors disclosed ties to the pharmaceutical industry. Please refer to reference for a complete list of authors’ disclosures.


Hoertel N, Blanco C, Olfson M, et al. A comprehensive model of predictors of suicide attempt in depressed individuals and effect of treatment-seeking behavior: results from a national 3-year prospective studyJ Clin Psychiatry 2018;79(5):e1-e8. doi:10.4088/JCP.17m11704