Time-related predictors of suicide in major affective disorder

Article Abstract:

Affective disorders are characterized by a disturbance in mood, and include major and manic depression. Since the prevention of suicide among patients is an important concern for clinicians, it is important to understand which patients are at high risk. Most studies of suicide have been retrospective, and therefore are susceptible to bias, and cannot provide standard clinical assessments. This study evaluated 954 patients (401 men and 553 women, all caucasian) with major affective disorders to identify clinical features associated with suicide. An initial report analyzed characteristics of patients who committed suicide or made a serious attempt by the end of a four-year follow-up period. This report analyzed characteristics that correlated with suicide over a 10-year period. It was predicted that different characteristics would be evident in those patients who were going to commit suicide within the first year after assessment (short-term suicides, 13 total) and those who were going to commit suicide after the first year (long-term suicides, 19 total). Statistical data on characteristics and the different ratings among short-term and long-term suicide victims, as well as those who did not commit suicide, are included. Especially significant was a higher rate of anhedonia (loss of interest or pleasure), psychic anxiety, obsessive-compulsive features, global insomnia, panic attacks, and alcohol abuse among the short-term suicide subjects. Suicidal ideation, hopelessness, and history of suicide attempts were characteristics that were significantly associated with long-term suicides. Hopelessness was more prevalent in both short- and long-term suicide subjects than in nonsuicide subjects. Diminished concentration and indecisiveness were marginally significant in predicting both short- and long-term suicides. The traditional suicide predictors, suicide ideation and previous suicide attempts, rated lower in short-term suicide subjects than in nonsuicide subjects, but rated significantly higher among long-term suicide subjects. It will need to be established if the short-term suicide subjects communicated suicidal thoughts and behaviors to people other than the clinician, such as relatives and friends. These finding show the importance of separating these two suicide groups when statistical analyses are performed for risk factors. It is suggested that patterns of characteristics are more predictive of patients at high risk for suicide than individual risk factors. Detecting these patterns can alert the clinician of the need for intervention. Larger analyses with different patient populations are recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Risk factors, Suicide, Suicide prevention

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Follow-up and family study of anxious depression

Article Abstract:

Anxiety and its features are not included as types or symptoms of depressive syndromes in the Diagnostic and Statistical Manual of Mental Disorders. This is despite the fact that anxiety symptoms are common in depressed patients and that a more accurate diagnosis for many of these patients might be anxious depression. This study examined the prevalence of six anxiety symptoms in depressed subjects to see if a new classification of anxious depression is needed. Data from 327 patients suffering from primary depressive disorder and no other preexisting psychiatric disorders were analyzed. The data included reported anxiety symptoms, family information, and five-year outcome. Most of the patients suffered from at least one anxiety symptom. Severe or moderate worrying was experienced by almost 75 percent of the patients, 26.9 percent reported suffering severe panic attacks, 41.6 percent reported severe or moderate anxiety producing somatic symptoms and 65.1 percent reported severe or moderate psychic anxiety. Patients with higher anxiety ratings took longer to recover (median of 26 weeks) than those with lower anxiety ratings (median of 13 weeks). Anxiety symptoms in the depressed subjects were not correlated with presence of anxiety disorders or alcoholism in the subjects. The results indicated that anxiety symptoms are an important factor in the primary depressive disorder of many patients and that the symptoms need to be recognized so that proper treatment can be effected. This suggests that a formal classification of anxious depression might prove useful. (Consumer Summary produced by Reliance Medical Information, Inc.)

Identification and classification, Mental illness, Mental disorders, Anxiety

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Gender differences in the clinical features of unipolar major depressive disorder

Article Abstract:

Previous studies have indicated that both the prevalence and severity of depression are greater among women than men. Less is known about the differences and similarities of clinical manifestations of depression between the sexes. The results of some studies have indicated that depressed men and women exhibit different symptoms and behaviors. To further investigate this, a total of 47 clinical features of depression were assessed in 206 men and 292 women diagnosed with nonpsychotic, unipolar major depressive disorder. All patients were considered to be moderately to severely depressed. The subjects were rated on the basis of the presence of a particular feature and the severity of this feature if detected. The data were derived from a review of medical records and from clinician ratings based on an interview with each patient; no self-reported symptoms of the patients were included. Some of the clinical features included increased appetite, weight gain, phobias, insomnia, fatigue, difficulty in concentrating, and somatic concerns (physical symptoms). In general, few differences were found between the men and the women. Only two clinical features distinguished the two groups: the women more often tended to have increased appetite and weight. It was concluded that although major depression may be more prevalent among women, the range of clinical symptoms in women and men with depression is similar. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Demographic aspects

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