The predictors of suicidal attempt in depressed patients

Abstract

Objectives : To examine the relationship between suicidal attempts and psychosocial stress, severity of depression, presence of personality pathology, comorbid conditions in depressed patients and identify the factors that can predict suicidal attempt Setting:King Chulalongkorn Memorial Hospital Design : Matched case-control study Subjects and method : ninety patients with age above 15 years who presented with suicidal attempt and had clinical of depression and met the eligible criteria for case and ninety depressed patients who met the criteria for control that matched for age and gender were conducted clinical diagnostic interview. Psychiatric diagnosis using DSM-IV criteria, details of the self-harm act, psychosocial stressor, past history and family history of psychiatric illness were assessed. Hamilton rating scale for depression, life events in social readjustment rating scale, 16 PF for personality profile and Zung self-rating anxiety scale were performed. Data were analyzed using percentage, McNemar Chi square, Odds Ratio, 95% Confidence Interval of odds ratio and conditional logistic regression. Results : Most cases of depressed patients were female (75.6%) and mean age 29 years (SD = 10.75). The method employed for suicidal attempt in cases was ingestion of drug or chemical agents (93.4%). Cases were more likely than controls to have current psychosocial stress, severe depression, recurrent depressive episode, history and family history of substance use, financial problem, lower level of education and personality profile that showed low intelligence. From conditional logistic regression analysis, the predictive factors to suicidal attempt in depressed patients were history of substance use, lower level of education and presence of stressful life event. Conclusion : Presence of current stressful life event, particularly family or interpersonal relationship problems, as well as history of substance use and lower level of education appear to have an important role in suicidal attempt in depressed patients. These findings underline the importance of adequate assessment of these factors when evaluating suicidal risk in depressed patients and development of preventive strategies for those patients.