Psychotic (delusional) depression and completed suicide: a systematic review and meta-analysis

Abstract

BackgroundIt remains unclear whether psychotic features increase the risk of completed suicides in unipolar depression. The present systematic review coupled with a meta-analysis attempts to elucidate whether unipolar psychotic major depression (PMD) compared to non-PMD presents higher rates of suicides.MethodsA systematic search was conducted in Scopus, PubMed, and “gray literature” for all studies providing data on completed suicides in PMD compared to non-PMD, and the findings were then subjected to meta-analysis. All articles were independently extracted by two authors using predefined data fields.ResultsNine studies with 33,873 patients, among them 828 suicides, met our inclusion criteria. PMD compared to non-PMD presented a higher lifetime risk of completed suicides with fixed-effect pooled OR 1.21 (95% CI 1.04–1.40). In a sub-analysis excluding a very large study (weight = 86.62%), and comparing 681 PMD to 2106 non-PMD patients, an even higher pooled OR was found [fixed-effect OR 1.69 (95% CI 1.16–2.45)]. Our meta-analysis may provide evidence that the presence of psychosis increases the risk of suicide in patients suffering from severe depression. The data are inconclusive on the contribution of age, mood congruence, comorbidity, and suicide method on PMD’s suicide risk. The lack of accurate diagnosis at the time of suicide, PMD’s diagnostic instability, and the use of ICD-10 criteria constitute the main study limitations.ConclusionsThe presence of psychosis in major depression should alert clinicians for the increased risk of completed suicide. Thus, the implementation of an effective treatment both for psychotic depression and patients’ suicidality constitutes a supreme priority.Electronic supplementary materialThe online version of this article (10.1186/s12991-018-0207-1) contains supplementary material, which is available to authorized users.

Recent Updates on Electro-Convulsive Therapy in Patients with Depression

“…Psychotic depression is accompanied by psychotic symptoms such as delusions or hallucinations. Epidemiological studies of psychotic disorder presented a prevalence of psychotic depression ranging from 0.35% to 1% and association with higher rate of recurrence, decreased quality of life, higher mortality rates, and higher risk of suicide [ 42 , 43 ].…”

“…Epidemiological studies of psychotic disorder presented a prevalence of psychotic depression ranging from 0.35% to 1% and association with higher rate of recurrence, decreased quality of life, higher mortality rates, and higher risk of suicide. 42,43 The expert opinions are inconsistent on the optimal treatment for psychotic depression, and the contents from nine international treatment guidelines are even contrasting. 42 Remission rate after application of ECT in psychotic unipolar depressed patients (n=77) was compared to those in nonpsychotic depressed patients (n=176).…”

Comorbid Anxiety and Suicidal Behaviors in American Adolescents With Major Depression

“…Patients with PMD during an MDD episode experience psychotic phenomena, are more impulsive, have intense feelings of guilt and anxiety, and, being in their disorganized mental state, are unable to control their actions, which lead to increased suicidal behavior [29]. In a meta-analysis study, patients with PMD had an elevated risk of suicide compared with severely depressed patients with PMD [30].…”

Brain changes in depression

“…▪ Psychotic depression, classically called depressive psychosis, involves a major depressive episode that associates delusional ideation, mostly guilt and guilt and/or visual illusions or auditory hallucinations (voices of deceased loved ones shouting at the person in question). Psychotic depression may occur in a recurrent depressive disorder or in a bipolar affective disorder [ 5 , 6 ].…”