Affective Disorders and Suicide Risk: A Reexamination

Abstract

The percentage of subjects dead due to suicide (case fatality prevalence) is a more appropriate estimate of suicide risk than the percentage of the dead who died by suicide (proportionate mortality prevalence). More important, it is well established that patients with affective disorders suffer a higher risk of suicide relative to the general population. However, no risk factor, including classification of diagnostic subtype, has been reliably shown to predict suicide. This article demonstrates a hierarchy of risk based on the intensity of the treatment setting. Given that patients with a hospitalization history, particularly when suicidal, have a much elevated suicide prevalence over both psychiatric outpatients and nonpatients, the clinical decision to hospitalize in and of itself appears to be a useful indicator of increased suicide risk.

Psychotic experiences and incident suicidal ideation and behaviour: Disentangling the longitudinal associations from connected psychopathology

“…Even though the mechanisms underlying suicidal behaviour remain poorly understood, research has shown that it is likely determined by a complex interplay of biological, psychological, environmental and cultural factors (O'Connor et al, 2011;World Health Organization, 2014). Mental disorders are an important risk factor for suicidal behaviour (Bostwick and Pankratz, 2000;Nordentoft et al, 2011;Palmer et al, 2005): of the individuals who committed suicide, 91% had a mental disorder, most commonly a depressive disorder, substance abuse or schizophrenia (Cavanagh et al, 2003;ten Have et al, 2009;Ten Have et al, 2013).…”

Cognitive Behavioral Therapy for Depression

“…Based on the results of a meta-analysis, the estimated risk *This chapter is an update of Powell et al's (2008) article. of suicide was 2.2% in less severe outpatients and 8.6% in those with more severe depression and a history of hospitalization (Bostwick & Pankratz, 2000). Because of its high prevalence and resulting disability (major depression is classified as the second greatest cause of disability, adjusted for years of life, in developed countries) (Murray & Lopez, 1996).…”

Revisiting impulsivity in suicide: Implications for civil liability of third parties

“…However, this rate differs depending on the population. For example, among individuals with mood disorders, there is a 2% suicide rate for outpatients, 6% suicide rate for inpatients hospitalized for suicidal symptoms, and 4.1% suicide rate for inpatients hospitalized for other reasons (Bostwick & Pankratz, 2000). Because it is not possible to be 100 percent accurate in predicting any human behavior, attempts to predict low base rate phenomena like suicide must be based on an algorithm that either errs on the side of over-prediction (false positives) or underprediction (false negatives).…”