Risk factors for suicide among 34,671 patients with psychotic and non-psychotic severe depression

UMMS Affiliation

Department of Psychiatry

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Document Type



Adult; Aged; Cohort Studies; Denmark; Depressive Disorder, Major; Female; Hospitals, Psychiatric; Humans; Logistic Models; Male; Middle Aged; Prospective Studies; Psychotic Disorders; Registries; Risk Factors; Suicide


Mental and Social Health | Psychiatry | Psychiatry and Psychology


BACKGROUND: Severe unipolar depression is associated with increased risk of suicide, but it remains unknown whether the same risk factors are present in the non-psychotic (non-PD) and psychotic (PD) subtypes respectively. Therefore, this study aimed to identify risk factors for suicide in non-PD and PD separately, and to investigate if the presence of psychotic symptoms is an independent risk factor for suicide in severe depression.

METHODS: This register-based, nationwide, historical prospective cohort study used logistic regression analyses to ascertain risk factors for suicide among all adults diagnosed with severe depression at Danish psychiatric hospitals between January 1, 1994 and December 31, 2010. The risk for suicide was expressed as adjusted odds ratios (AOR).

RESULTS: A total of 34,671 individuals with severe depression (non-PD: n=26,106 and PD: n=12,101) were included in the study. Of these, 755 completed suicide during follow up. PD was not found to be an independent risk factor for suicide in severe depression (AOR=0.97 [0.83-1.15]). Older age (non-PD AOR=1.05 [per year], PD AOR=1.04 [per year]), male sex (non-PD AOR=1.89, PD AOR=1.98), and a previous incident of self-harm (non-PD AOR=5.02, PD AOR=5.17) were significant risk factors for both groups.

LIMITATIONS: As the study population was comprised only of patients with contact to psychiatric hospitals, the results cannot be extrapolated to the primary care setting.

CONCLUSION: The following risk factors for non-PD and PD were identified: older age, male gender and previous incidents of self-harm. In suicide prevention efforts, equal attention should be paid to non-PD and PD patients.

DOI of Published Version



J Affect Disord. 2014 Mar;156:119-25. doi: 10.1016/j.jad.2013.12.003 Link to article on publisher's site

Journal/Book/Conference Title

Journal of affective disorders

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Link to Article in PubMed

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