Suicidality in Major Depressive Disorder : The Impact of Psychiatric Comorbidity

Ji-Won Jung; Hee-Cheol Kim; Jung-Kyu Sakong; Hyung-Mo Sung; Sung-Won Jung; Eun-Jung Lee; Im-Hee Shin; Jung-Bum Kim

doi:10.0000/jkna.2012.51.2.85

Journal List > J Korean Neuropsychiatr Assoc > v.51(2) > 1017620

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Jung, Kim, Sakong, Sung, Jung, Lee, Shin, and Kim: Suicidality in Major Depressive Disorder : The Impact of Psychiatric Comorbidity

Original Article

Journal of the Korean Neuropsychiatric Association

Journal of the Korean Neuropsychiatric Association 2012; 51(2): 85-92.

Published online: 31 March 2012

DOI: https://doi.org/10.0000/jkna.2012.51.2.85

Suicidality in Major Depressive Disorder : The Impact of Psychiatric Comorbidity

Ji-Won Jung, MD¹, Hee-Cheol Kim, MD, PhD¹, Jung-Kyu Sakong, MD, PhD², Hyung-Mo Sung, MD, PhD³, Sung-Won Jung, MD, PhD¹, Eun-Jung Lee, MA¹, Im-Hee Shin, PhD⁴, Jung-Bum Kim, MD, PhD¹

¹Department of Psychiatry, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

²Department of Psychiatry, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea.

³Department of Psychiatry, CHA Gumi Medical Center, College of Medicine, CHA University, Gumi, Korea.

⁴Department of Biostatistics, Catholic University of Daegu School of Medicine, Daegu, Korea.

Address for correspondence: Jung-Bum Kim, MD, PhD. Department of Psychiatry, Dongsan Medical Center, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Korea. Tel +82-53-250-7931, Fax +82-53-250-7810, kim1159@dsmc.or.kr

Received 20 December 2011 Revised 21 January 2012 Accepted 31 January 2012

Abstract

Objectives

Generally, major depressive disorder (MDD) with psychiatric comorbidities is associated with a high suicide rate. However, this relationship has not been studied much in Korea. In this study, we evaluated the suicidality in MDD with psychiatric comorbidities.

Methods

This study was performed on patients who visited the psychiatric department of three university hospitals in the Gyeongbuk area from March 2008 to September 2011. In total, 776 patients were evaluated with the Mini-International Neuropsychiatric Interview-Plus (MINI-Plus), and 288 with MDD were recruited for the study. Suicidality and suicidal risks were evaluated in the MINI-Plus questionnaire.

Results

MDD patients with comorbidities had a significantly higher suicidality and suicidal risk than patients with pure MDD. Suicidality was significantly higher in an anxiety disorder group with comorbidity than in the pure MDD group. As the total number of comorbidities got higher, the suicidality increased, and suicidal risks had significant differences depending on the total number of comorbidities.

Conclusion

These results suggest that an MDD patient with comorbidities has a higher suicidality and suicidal risk. In clinical settings, comorbid MDD patients should be approached with more aggressive psychiatric intervention of their suicidal thoughts and actions.

Keywords: Major depressive disorder, Comorbidity, Suicidality, Suicidal risk

References

1. Organization for Economic Cooperation and Development. OECD health data 2009: statistics and indicators for 30 countries. 2010. Paris: Organization for Economic Cooperation and Development.

2. Statistics Korea. Death statistics in 2009. 2010. Daejeon: Statistics Korea.

3. Conwell Y, Duberstein PR, Cox C, Herrmann JH, Forbes NT, Caine ED. Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study. Am J Psychiatry. 1996. 153:1001–1008.

4. Jeon HJ, Lee JY, Lee YM, Hong JP, Won SH, Cho SJ, et al. Lifetime prevalence and correlates of suicidal ideation, plan, and single and multiple attempts in a Korean nationwide study. J Nerv Ment Dis. 2010. 198:643–646.

5. Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM. Psychological autopsy studies of suicide: a systematic review. Psychol Med. 2003. 33:395–405.

6. Henriksson MM, Aro HM, Marttunen MJ, Heikkinen ME, Isometsä ET, Kuoppasalmi KI, et al. Mental disorders and comorbidity in suicide. Am J Psychiatry. 1993. 150:935–940.

7. Cho MJ, Chang SM, Hahm BJ, Chung IW, Bae A, Lee YM, et al. Prevalence and correlates of major mental disorders among Korean Adults: a 2006 National Epidemiologic Survey. J Korean Neuropsychiatr Assoc. 2009. 48:143–152.

8. Sainsbury P. Roy A, editor. Depression, suicide, and suicide prevention. Suicide. 1986. Balimore: Williams & Wilkins;73–88.

9. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet. 1997. 349:1436–1442.

10. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet. 1997. 349:1498–1504.

11. Zimmerman M, McDermut W, Mattia JI. Frequency of anxiety disorders in psychiatric outpatients with major depressive disorder. Am J Psychiatry. 2000. 157:1337–1340.

12. Kessler RC, Stang PE, Wittchen HU, Ustun TB, Roy-Burne PP, Walters EE. Lifetime panic-depression comorbidity in the National Comorbidity Survey. Arch Gen Psychiatry. 1998. 55:801–808.

13. Keller MB, Hanks DL. Anxiety symptom relief in depression treatment outcomes. J Clin Psychiatry. 1995. 56:Suppl 6. 22–29.

14. Beautrais AL, Joyce PR, Mulder RT, Fergusson DM, Deavoll BJ, Nightingale SK. Prevalence and comorbidity of mental disorders in persons making serious suicide attempts: a case-control study. Am J Psychiatry. 1996. 153:1009–1014.

15. Dumais A, Lesage AD, Alda M, Rouleau G, Dumont M, Chawky N, et al. Risk factors for suicide completion in major depression: a case-control study of impulsive and aggressive behaviors in men. Am J Psychiatry. 2005. 162:2116–2124.

16. Spitzer RL, Williams JB, Gibbon M, First MB. The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. Arch Gen Psychiatry. 1992. 49:624–629.

17. Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, et al. The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry. 1988. 45:1069–1077.

18. Yoo SW, Kim YS, Noh JS, Oh KS, Kim CH, NamKoong K, et al. Validity of Korean version of the Mini-International Neuropsychiatric Interview. Anxiety and Mood. 2006. 2:50–55.

19. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Clin Psychiatry. 1998. 59:Suppl 20. 22–33. quiz 34–quiz 57.

20. Melartin TK, Rytsälä HJ, Leskelä US, Lestelä-Mielonen PS, Sokero TP, Isometsä ET, et al. Current comorbidity of psychiatric disorders among DSM-IV major depressive disorder patients in psychiatric care in the Vantaa Depression Study. J Clin Psychiatry. 2002. 63:126–134.

21. Zimmerman M, Mattia JI. Psychiatric diagnosis in clinical practice: is comorbidity being missed? Compr Psychiatry. 1999. 40:182–191.

22. Rush AJ, Zimmerman M, Wisniewski SR, Fava M, Hollon SD, Warden D, et al. Comorbid psychiatric disorders in depressed outpatients:demographic and clinical features. J Affect Disord. 2005. 87:43–55.

23. Kleinknecht RA, Dinnel DL, Kleinknecht EE, Hiruma N, Harada N. Cultural factors in social anxiety: a comparison of social phobia symptoms and Taijin kyofusho. J Anxiety Disord. 1997. 11:157–177.

24. McDermut W, Mattia J, Zimmerman M. Comorbidity burden and its impact on psychosocial morbidity in depressed outpatients. J Affect Disord. 2001. 65:289–295.

25. Suominen K, Henriksson M, Suokas J, Isometsä E, Ostamo A, Lönnqvist J. Mental disorders and comorbidity in attempted suicide. Acta Psychiatr Scand. 1996. 94:234–240.

26. Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry. 1999. 56:617–626.

27. Angst J, Sellaro R, Ries Merikangas K. Multimorbidity of psychiatric disorders as an indicator of clinical severity. Eur Arch Psychiatry Clin Neurosci. 2002. 252:147–154.

28. Hawton K, Houston K, Haw C, Townsend E, Harriss L. Comorbidity of axis I and axis II disorders in patients who attempted suicide. Am J Psychiatry. 2003. 160:1494–1500.

29. Pfeiffer PN, Ganoczy D, Ilgen M, Zivin K, Valenstein M. Comorbid anxiety as a suicide risk factor among depressed veterans. Depress Anxiety. 2009. 26:752–757.

30. Fawcett J. Fawcett J. Treating impulsivity and anxiety in the suicidal patient. Ann N Y Acad Sci. 2001. 932:94–102. discussion 102-105.

31. Mann JJ, Waternaux C, Haas GL, Malone KM. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry. 1999. 156:181–189.

32. Nock MK, Hwang I, Sampson NA, Kessler RC. Mental disorders, comorbidity and suicidal behavior: results from the National Comorbidity Survey Replication. Mol Psychiatry. 2010. 15:868–876.

33. Schulberg HC, Lee PW, Bruce ML, Raue PJ, Lefever JJ, Williams JW Jr, et al. Suicidal ideation and risk levels among primary care patients with uncomplicated depression. Ann Fam Med. 2005. 3:523–528.

34. Gensichen J, Teising A, König J, Gerlach FM, Petersen JJ. Predictors of suicidal ideation in depressive primary care patients. J Affect Disord. 2010. 125:124–127.

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