Suicidal Career in Severe Depression among Long-Term Survivors: In a Followup after 37–53 Years Suicide Attempts Appeared to End Long before Depression

Objective. To describe the suicidal career in the long-term course of severe depression. Subjects and Method. Seventy-five former in-patients were interviewed by telephone about course of depression and suicide attempts 37–53 years after index admission. Medical records were read in many cases. Results. 29 subjects had attempted suicide, 13 repeated, 10 made severe, and 13 violent attempts. The risk of suicide attempt decreased by 10% for every decade spent depressed. Suicide attempts were made early in course of depression, and more time was spent depressed after suicide attempts than before. Conclusions. A healing process of the suicidal career, which may occur long before the end of the last depressive episode (sometimes decades), is proposed. 1. Introduction Depression is a common disease [1]. It is one of the leading causes of disability worldwide, and it is a major contributor to the global burden of disease [2]. Suicide is a feared outcome of depressive disorders. A review article calculated the life time risk of committing suicide to 6% in affective disorder [3]. Mood disorders is one of the diagnoses that convey the highest risk for suicidal behavior in high-income countries [4]. Different studies have shown that 43% to 60% of all suicide victims suffered from mood disorders [5–8], and, when dysthymia was included, 90% of the suicide victims were shown to have suffered from a depressive disorder according to one study [9]. Severe depression (major depressive disorder with melancholic or psychotic features/endogenous depression) has been shown to predominate in the depressive group of suicide victims [10, 11]. Attempted suicide is important in the study of suicide since it is the most important known risk factors for completed suicide [12–15]. Different studies have shown rates of attempted suicide between 15% [13] and 34% [16] for patients with major depressive disorder. Subjects with major depressive disorder who have attempted suicide have an increased risk of reattempting [17]. The risk of suicide attempts among depressive patients has been found to be strongly associated with the presence and severity of depressive symptoms [17]. It has also been proposed that length of time spent depressed is likely to be the major risk factor for the overall long-term risk of suicide attempts [13]. Number of depressive episodes has been shown to be positively correlated with the number of suicide attempts [12, 18]. On the other hand, it has been proposed that suicide attempts occur early in the course of depression [19–23] and it has been shown that those