In a population-based cohort study published in JAMA Psychiatry, researchers sought to describe the clinical and societal outcomes, including all-cause mortality, of suicidal behavior in patients with major depressive disorder (MDD) and to investigate related risk factors and clinical management to guide future research and guidelines.

The primary outcome was all-cause mortality, and secondary outcomes were comorbid conditions, medications, healthcare resource utilization (HCRU), and work loss. Utilizing Region Stockholm registry variables, a risk score for factors correlated with suicidal behavior within 1 year after the start of an MDD episode was calculated.

Patients aged 18 years or older with episodes of MDD diagnosed between January 1, 2012, and December 31, 2017, in any healthcare setting were included. The data analysis dates were from February 1, 2022, to November 1, 2022.

A total of 158,169 unipolar MDD episodes were identified in 145,577 patients; in 2,219 patients, 2,240 (1.4%) of these episodes included records of suicidal behavior (SB; mean [SD] patient age, 40.9 [18.6] years; 1,415 episodes [63.2%] in women and 825 [36.8%] in men).

A total of 11,109 MDD episodes in 9,574 matched patients with MDD without records of suicidal behavior were included as controls (mean [SD] patient age, 40.8 [18.5] years; 7,046 episodes [63.4%] in women and 4,063 [36.6%] in men).

Based on 466 deaths, the all-cause mortality rate was 2.5 per 100 person-years at risk for the MDD-SB group and 1.0 per 100 person-years at risk for the MDD non-SB group. The authors noted that compared with the matched controls, suicidal behavior was correlated with higher all-cause mortality and with HCRU and work loss. Additionally, patients with MDD and suicidal behavior were younger and more inclined to have psychiatric comorbid conditions (e.g., personality disorders, substance use, and anxiety) at the start of their episode.

The authors indicated that in this cohort study of 158,169 unipolar MDD episodes, 1.4% included records of suicidal behavior, and the all-cause mortality among patients with suicidal behavior was 2.6 times higher than among matched patients with MDD without records of suicidal behavior.

Within 1 year after the start of an MDD episode, the most critical factors correlated with suicidal behavior were history of suicidal behavior and age, history of substance use and sleep disorders, and care setting in which MDD was diagnosed.

The authors concluded, “This cohort study’s findings suggest that high mortality, morbidity, HCRU, and work loss associated with MDD may be substantially accentuated in patients with MDD and suicidal behavior. Use of medication aimed at decreasing the risk of all-cause mortality during MDD episodes should be systematically evaluated to improve long-term outcomes.”

Finally, the authors indicated that among these patients, the all-cause mortality was more than doubled compared with MDD episodes without records of suicidal behavior. The results of this study also revealed that patients at risk for suicidal behavior can be identified at an early stage to permit enhanced monitoring and optimized treatment with the goal of thwarting suicidal behavior and diminishing mortality.

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