Sex Differences in Clinical Predictors of Suicidal Acts After Major Depression: A Prospective Study

Abstract

Objective-Whether sex differences exist in clinical risk factors associated with suicidal behavior is unknown. The authors postulated that among men with a major depressive episode, aggression, hostility, and history of substance misuse increase risk for future suicidal behavior, while depressive symptoms, childhood history of abuse, fewer reasons for living, and borderline personality disorder do so in depressed women.Method-Patients with DSM-III-R major depression or bipolar disorder seeking treatment for a major depressive episode (N=314) were followed for 2 years. Putative predictors were tested with Cox proportional hazards regression analysis.Results-During follow-up, 16.6% of the patients attempted or committed suicide. Family history of suicidal acts, past drug use, cigarette smoking, borderline personality disorder, and early parental separation each more than tripled the risk of future suicidal acts in men. For women, the risk for future suicidal acts was sixfold greater for prior suicide attempters; each past attempt increased future risk threefold. Suicidal ideation, lethality of past attempts, hostility, subjective depressive symptoms, fewer reasons for living, comorbid borderline personality disorder, and cigarette smoking also increased the risk of future suicidal acts for women.Conclusions-These findings suggest that the importance of risk factors for suicidal acts differs in depressed men and women. This knowledge may improve suicide risk evaluation and guide future research on suicide assessment and prevention.Sex differences in suicidal behavior have long been recognized (1)(2)(3)(4)(5). Studies have shown that men have higher suicide rates (1), while women are at higher risk for suicide attempts (2, 5). Possible explanations include differences in the propensity to use lethal means, suicidal intent, and the use of substances within the context of suicidal behavior (3, 6).Few cross-sectional studies have compared sex differences in the characteristics of suicide attempters. Adolescent male suicide victims are more likely to have conduct and substance use disorders, while female adolescents more frequently suffer from mood or anxiety disorders and have attempted suicide before (6). Among adolescents and young adults (2), female attempters were more likely to have posttraumatic stress disorder; attempts by males were more often triggered by financial problems. Four prospective studies (7-10) have compared risk factors for suicidal behavior in the two genders. Two studies of overlapping study groups examined 1,026 depressed melancholic inpatients and showed that, compared to matched depressed comparison subjects, female suicide victims more often were unmarried, were noncompliant with treatment, and had previously attempted suicide, while NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript suicide in men was related to heredity for psychosis and brittle or sensitive personality (7,9). Another multisite prospective study of 3,130 teenagers assessed anger at oneself, ...

The role of moral objections to suicide in the assessment of suicidal patients

“…There were significant differences in the two cities with regard to several demographic and clinical variables (see Section 3). Two hundred and ninety-five (95.6%) patients from this study were also reported in previous studies (Dervic et al, 2004;Oquendo et al, 2004Oquendo et al, , 2007Lizardi et al, 2007). Exclusion criteria included current substance or alcohol abuse, neurological illness or other active medical conditions.…”

Elevated cytokine expression in the orbitofrontal cortex of victims of suicide

“…Moreover, elevated IL-13 in suicide women was observed but the differences were not significant. The finding of increased IL-13 in suicide men may be related to several other factors including those related to the reported gender effects in suicidal behavior (43,44) and the specific functions of this cytokine (45). In this regard, it should be highlighted that while there is abundant information about gender differences in suicide risk factors and suicidal behavior, to our knowledge, postmortem studies have not reported major neurochemical or gene expression differences between the brain of suicides women and men.…”

Years of Life Lost Due to External Causes of Death in the Lodz Province, Poland

“…Women are not affected by the above negative social phenomena to such an extent as men. They are protected by maternity duties, use social help more often than males and are less prone to risktaking and becoming addicted to alcohol [41].…”