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 association between smoking and subsequent suicide-related outcomes in the National Comorbidity Survey panel sample

“…Statistically significant associations similar to those between smoking and suicide deaths have been documented between smoking and SROs in cross-sectional8–10 and prospective9, 11 studies in both general population samples8–10, 12 and clinical samples 13, 14. These associations have held up after controlling for socio-demographics and limited measures of psychological functioning (including measures of depression and drug use disorders).…”

Do risk factors for suicidal behavior differ by affective disorder polarity?

“…Several studies have assessed suicide risk factors in unipolar and bipolar disorders (Fawcett et al , 1990; Krupinski et al , 1998; Schneider et al , 2001; Angst et al , 2002; Oquendo et al , 2007; Tondo et al , 2007), and some have conducted separate analyses by polarity (Black et al , 1988; Kallner et al , 2000; Angst et al , 2005a). An assumption of the former studies is that risk factors do not vary by diagnosis and the latter studies do little to validate this assumption.…”

A population-based longitudinal study of risk factors for suicide attempts in major depressive disorder

“…Depression severity (Roy, 1993), comorbid personality (Corbitt et al, 1996; Soloff et al, 2000), anxiety (Bolton et al, 2008; Stein et al, 2001), and alcohol use disorders (Bulik et al, 1990; Claassen et al, 2007) have all been associated with an elevated risk of suicide attempt. Longitudinal studies have consistently demonstrated the importance of past suicide attempts (Oquendo et al, 2005; Oquendo et al, 2007; Sokero et al, 2005), cigarette smoking (Oquendo et al, 2005; Oquendo et al, 2007), alcohol use disorders (Maser et al, 2002), and comorbid personality disorder (Hansen et al, 2003; Oquendo et al, 2007) as predictors of future suicide attempts in depressed populations.…”