Previous research has established that MDD is a significant risk factor for suicidal behavior. In a recent publication in the Journal of the American Medical Association Psychiatry, researchers conducted a cohort study to assess the clinical and societal outcomes, including all-cause mortality, of suicidal behavior in patients with MDD and to investigate the associated risk factors and clinical management to update future research and guidelines.
This population-based cohort study utilized healthcare data from the Stockholm MDD Cohort. 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 February 1, 2022, to November 1, 2022.
The authors wrote, “In this study, we investigated the all-cause mortality associated with MDD episodes with suicidal behavior (MDD-SB) compared with MDD episodes without records of suicidal behavior (MDD-non-SB). We also aimed to describe patient clinical characteristics, such as comorbid conditions, treatment patterns, health care resource utilization (HCRU), and work loss. Furthermore, in a separate analysis, we identified risk factors of suicidal behavior in patients with MDD based on information available at the start of an MDD episode.”
The primary outcome was all-cause mortality, and secondary outcomes were comorbid conditions, medications, HCRU, and work loss. A risk score for factors associated with suicidal behavior within 1 year after the start of an MDD episode was calculated by utilizing Region Stockholm registry variables.
The researchers indicated that 158,169 unipolar MDD episodes were identified in 145,577 patients; 2,240 (1.4%) of these episodes, in 2,219 patients, included records of suicidal behavior (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).
The results revealed that of the 158,169 unipolar MDD episodes, 1.4% involved 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.
The authors also noted that 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 episodes. The most critical factors correlated with suicidal behavior within 1 year after the beginning of an MDD episode were history of suicidal behavior and age, with the highest risks for those aged younger than 20 years or older than 70 years. The researchers also indicated that the final risk score also encompassed the following factors (in descending order), the presence of which augmented the risk for the outcome: history of substance use, history of sleep disorders, healthcare level in which MDD was diagnosed, history of antidepressant use, and history of anxiety disorders.
Based on their findings, the authors concluded that elevated mortality, morbidity, healthcare resource utilization, and work loss linked with MDD may be significantly heightened in patients with MDD and suicidal behavior, and the use of medication to reduce the risk of all-cause mortality during MDD episodes should be systematically assessed to enhance long-term goals and clinical outcomes.
Lastly, the authors concluded, “Among these patients, the all-cause mortality was more than doubled compared with MDD episodes without records of suicidal behavior. Our results also indicate that patients at risk for suicidal behavior can be identified at an early stage to allow for enhanced monitoring and optimized treatment with the goal of preventing suicidal behavior and reducing mortality.”
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.