Hostname: page-component-745bb68f8f-b95js Total loading time: 0 Render date: 2025-01-10T23:31:12.684Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence of suicide attempt in individuals with major depressive disorder: a meta-analysis of observational surveys

Published online by Cambridge University Press:  04 September 2018

Min Dong ,
Liang-Nan Zeng ,
Li Lu ,
Xiao-Hong Li ,
Gabor S. Ungvari ,
Chee H. Ng ,
Ines H. I. Chow ,
Ling Zhang ,
Yuan Zhou  and
Yu-Tao Xiang
Min Dong
Affiliation:
Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
Liang-Nan Zeng
Affiliation:
Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
Li Lu
Affiliation:
Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
Xiao-Hong Li
Affiliation:
The National Clinical Research Center for Mental Disorders, China & Center of Depression, Beijing Institute for Brain Disorders & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China
Gabor S. Ungvari
Affiliation:
University of Notre Dame Australia/Marian Centre, Perth, Australia
Chee H. Ng
Affiliation:
Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
Ines H. I. Chow
Affiliation:
Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
Ling Zhang
Affiliation:
Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
Yuan Zhou
Affiliation:
CAS Key Laboratory of Behavioral Science & Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
Yu-Tao Xiang*
Affiliation:
Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
*
Author for correspondence: Yu-Tao Xiang, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Suicide attempt (SA), which is one of the strongest predictors of completed suicide, is common in major depressive disorder (MDD) but its prevalence across epidemiological studies has been mixed. The aim of this comprehensive meta-analysis was to examine the pooled prevalence of SA in individuals with MDD.

Methods

A systematic literature search was conducted in PubMed, Embase, PsycINFO, Web of Science and Cochrane Library from their commencement date until 27 December 2017. Original studies containing data on prevalence of SA in individuals with MDD were analyzed.

Results

In all, 65 studies with a total of 27 340 individuals with MDD were included. Using the random effects model, the pooled lifetime prevalence of SA was 31% [95% confidence interval (CI) 27–34%], 1-year prevalence was 8% (95% CI 3–14%) and 1-month prevalence was 24% (95% CI 15–34%). Subgroup analyses revealed that the lifetime prevalence of SA was significantly associated with the patient setting, study region and income level, while the 1-month prevalence of SA was associated with only the patient setting.

Conclusion

This meta-analysis confirmed that SA was common in individuals with MDD across the world. Careful screening and appropriate interventions should be implemented for SA in the MDD population.

Keywords

Major depressive disordermeta-analysissuicide attempt
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 10 , July 2019 , pp. 1691 - 1704
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

These authors contributed equally to this work.

References

Abdollahian, E, Gharavi, MM, Soltanifar, A and Mokhber, N (2009) Relationship between positive and negative symptoms of schizophrenia and psychotic depression with risk of suicide. Iranian Journal of Psychiatry and Behavioral Sciences 3, 27–32.Google Scholar
Andrade, L, Caraveo-anduaga, JJ, Berglund, P, Bijl, RV, Graaf, RD, Vollebergh, W, Dragomirecka, E, Kohn, R, Keller, M and Kessler, RC (2003) The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. International Journal of Methods in Psychiatric Research 12, 3–21.Google Scholar
Arling, TA, Yolken, RH, Lapidus, M, Langenberg, P, Dickerson, FB, Zimmerman, SA, Balis, T, Cabassa, JA, Scrandis, DA and Tonelli, LH (2009) Toxoplasma gondii antibody titers and history of suicide attempts in patients with recurrent mood disorders. Journal of Nervous and Mental Disease 197, 905–908.Google Scholar
Asnis, GM, Friedman, TA, Sanderson, WC, Kaplan, ML, Van Praag, HM and Harkavy-Friedman, JM (1993) Suicidal behaviors in adult psychiatric outpatients, 1. Description and Prevalence. American Journal of Psychiatry 150, 108–112.Google Scholar
Atay, IM, Eren, I and Gundogar, D (2012) The prevalence of death ideation and attempted suicide and the associated risk factors in Isparta, Turkey. Turk Psikiyatri Dergisi 23, 89–98.Google Scholar
Baek, JH, Kang, ES, Fava, M, Mischoulon, D, Nierenberg, AA, Yu, BH, Lee, D and Jeon, HJ (2014) Serum lipids, recent suicide attempt and recent suicide status in patients with major depressive disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry 51, 113–118.Google Scholar
Baek, JH, Heo, JY, Fava, M, Mischoulon, D, Nierenberg, A, Hong, JP, Roh, S and Jeon, HJ (2015) Anxiety symptoms are linked to new-onset suicidal ideation after six months of follow-up in outpatients with major depressive disorder. Journal of Affective Disorders 187, 183–187.Google Scholar
Banwari, GH, Vankar, GK and Parikh, MN (2013) Comparison of suicide attempts in schizophrenia and major depressive disorder: an exploratory study. Asia and Pacific Psychiatry 5, 309–315.Google Scholar
Beautrais, AL (2000) Risk factors for suicide and attempted suicide among young people. Australian and New Zealand Journal of Psychiatry 34, 420–436.Google Scholar
Begg, CB and Mazumdar, M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50, 1088–1101.Google Scholar
Beier, AM, Lauritzen, L, Galfalvy, HC, Cooper, TB, Oquendo, MA, Grunebaum, MF, Mann, JJ and Sublette, ME (2014) Low plasma eicosapentaenoic acid levels are associated with elevated trait aggression and impulsivity in major depressive disorder with a history of comorbid substance use disorder. Journal of Psychiatric Research 57, 133–140.Google Scholar
Ben-Zeev, D, Young, MA and Depp, CA (2012) Real-time predictors of suicidal ideation: mobile assessment of hospitalized depressed patients. Psychiatry Research 197, 55–59.Google Scholar
Berlin, I, Payan, C, Corruble, E and Puech, AJ (1999) Serum thyroid-stimulating-hormone concentration as an index of severity of major depression. International Journal of Neuropsychopharmacology 2, 105–110.Google Scholar
Berman, AL, Silverman, MM and Bongar, BM (2000) Comprehensive Textbook of Suicidology. New York: Guilford Press.Google Scholar
Bernal, M, Haro, JM, Bernert, S, Brugha, T, de Graaf, R, Bruffaerts, R, Lepine, JP, de Girolamo, G, Vilagut, G, Gasquet, I, Torres, JV, Kovess, V, Heider, D, Neeleman, J, Kessler, R and Alonso, J (2007) Risk factors for suicidality in Europe: results from the ESEMED study. Journal of Affective Disorders 101, 27–34.Google Scholar
Black, C and Miller, BJ (2015) Meta-analysis of cytokines and chemokines in suicidality: distinguishing suicidal versus nonsuicidal patients. Biological Psychiatry 78, 28–37.Google Scholar
Blair-West, GW, Cantor, CH, Mellsop, GW and Eyeson-Annan, ML (1999) Lifetime suicide risk in major depression: sex and age determinants. Journal of Affective Disorders 55, 171–178.Google Scholar
Cao, X-L, Zhong, B-L, Xiang, Y-T, Ungvari, GS, Lai, KY, Chiu, HF and Caine, ED (2015) Prevalence of suicidal ideation and suicide attempts in the general population of China: a meta-analysis. International Journal of Psychiatry in Medicine 49, 296–308.Google Scholar
Cao, XL, Wang, SB, Zhong, BL, Zhang, L, Ungvari, GS, Ng, CH, Li, L, Chiu, HFK, Lok, GKI, Lu, JP, Jia, FJ and Xiang, YT (2017) The prevalence of insomnia in the general population in China: a meta-analysis. PLoS One 12, e0170772.Google Scholar
Carlberg, L, Schosser, A, Calati, R, Serretti, A, Massat, I, Papageorgiou, K, Kocabas, NA, Mendlewicz, J, Zohar, J, Montgomery, SA, Souery, D and Kasper, S (2015) Association study of CREB1 polymorphisms and suicidality in MDD: results from a European multicenter study on treatment resistant depression. International Journal of Neuroscience 125, 336–343.Google Scholar
Cavanagh, JT, Carson, AJ, Sharpe, M and Lawrie, SM (2003) Psychological autopsy studies of suicide: a systematic review. Psychological Medicine 33, 395–405.Google Scholar
Chan, LF, Maniam, T and Shamsul, AS (2011) Suicide attempts among depressed inpatients with depressive disorder in a Malaysian sample: psychosocial and clinical risk factors. Crisis: Journal of Crisis Intervention and Suicide Prevention 32, 283–287.Google Scholar
Chen, YF (2002) Chinese classification of mental disorders (CCMD-3): towards integration in international classification. Psychopathology 35, 171–175.Google Scholar
Chen, YW and Dilsaver, SC (1996) Lifetime rates of suicide attempts among subjects with bipolar and unipolar disorders relative to subjects with other Axis I disorders. Biological Psychiatry 39, 896–899.Google Scholar
Chen, S-J, Shi, L, Bao, Y-P, Sun, Y-K, Lin, X, Que, J-Y, Vitiello, MV, Zhou, Y-X, Wang, Y-Q and Lu, L (2018) Prevalence of restless legs syndrome during pregnancy: a systematic review and meta-analysis. Sleep Medicine Reviews 40, 43–54.Google Scholar
Cleare, AJ (1997) Reduced whole blood serotonin in major depression. Depression and Anxiety 5, 108–111.Google Scholar
Coentre, R, Talina, MC, Góis, C and Figueira, ML (2017) Depressive symptoms and suicidal behavior after first-episode psychosis: a comprehensive systematic review. Psychiatry Research 253, 240–248.Google Scholar
Colle, R, Chupin, M, Cury, C, Vandendrie, C, Gressier, F, Hardy, P, Falissard, B, Colliot, O, Ducreux, D & Corruble, E (2015) Depressed suicide attempters have smaller hippocampus than depressed patients without suicide attempts. Journal of Psychiatric Research 61, 13–18.Google Scholar
Conrad, R, Walz, F, Geiser, F, Imbierowicz, K, Liedtke, R and Wegener, I (2009) Temperament and character personality profile in relation to suicidal ideation and suicide attempts in major depressed patients. Psychiatry Research 170, 212–217.Google Scholar
Corruble, E, Damy, C and Guelfi, J (1999) Impulsivity: a relevant dimension in depression regarding suicide attempts? Journal of Affective Disorders 53, 211–215.Google Scholar
Corruble, E, Bronnec, M, Falissard, B and Hardy, P (2004) Defense styles in depressed suicide attempters. Psychiatry and Clinical Neurosciences 58, 285–288.Google Scholar
Coryell, W, Pfohl, B and Zimmerman, M (1984) The clinical and neuroendocrine features of psychotic depression. Journal of Nervous and Mental Disease 172, 521–528.Google Scholar
Courtet, P, Giner, L, Seneque, M, Guillaume, S, Olie, E and Ducasse, D (2016) Neuroinflammation in suicide: toward a comprehensive model. World Journal of Biological Psychiatry 17, 564–586.Google Scholar
Courtett, P, Jaussent, I, Lopez-Castroman, J and Gorwood, P (2014) Poor response to antidepressants predicts new suicidal ideas and behavior in depressed outpatients. European Neuropsychopharmacology 24, 1650–1658.Google Scholar
Cyprien, F, de Champfleur, NM, Deverdun, J, Olie, E, Le Bars, E, Bonafe, A, Mura, T, Jollant, F, Courtet, P and Artero, S (2016) Corpus callosum integrity is affected by mood disorders and also by the suicide attempt history: a diffusion tensor imaging study. Journal of Affective Disorders 206, 115–124.Google Scholar
Dervic, K, Grunebaum, MF, Burke, AK, Mann, JJ and Oquendo, MA (2006) Protective factors against suicidal behavior in depressed adults reporting childhood abuse. Journal of Nervous and Mental Disease 194, 971–974.Google Scholar
Dickerson, F, Adamos, M, Katsafanas, E, Khushalani, S, Origoni, A, Savage, C, Schweinfurth, L, Stallings, C, Sweeney, K, Alaedini, A, Uhde, M, Severance, E, Wilcox, HC and Yolken, R (2017) The association between immune markers and recent suicide attempts in patients with serious mental illness: a pilot study. Psychiatry Research 255, 8–12.Google Scholar
Dieserud, G, Gerhardsen, RM, Van den Weghe, H and Corbett, K (2010) Adolescent suicide attempts in Baerum, Norway, 1984–2006. Crisis 31, 255–264.Google Scholar
Dilsaver, SC, Benazzi, F, Akiskal, KK and Akiskal, HS (2008) Differential patterns of lifetime multiple anxiety disorder comorbidity between Latino adults with bipolar I and major depressive disorders. Bulletin of the Menninger Clinic 72, 130–148.Google Scholar
Dumais, A, Lesage, AD, Alda, M, Rouleau, G, Dumont, M, Chawky, N, Roy, M, Mann, JJ, Benkelfat, C and Turecki, G (2005) Risk factors for suicide completion in major depression: a case-control study of impulsive and aggressive behaviors in men. American Journal of Psychiatry 162, 2116–2124.Google Scholar
Ekinci, O, Albayrak, Y and Ekinci, AE (2012) Temperament and character in euthymic major depressive disorder patients: the effect of previous suicide attempts and psychotic mood episodes. Psychiatry Investigation 9, 119–126.Google Scholar
Feixas, G, Montesano, A, Compan, V, Salla, M, Dada, G, Pucurull, O, Trujillo, A, Paz, C, Munoz, D, Gasol, M, Saul, LA, Lana, F, Bros, I, Ribeiro, E, Winter, D, Carrera-Fernandez, MJ and Guardia, J (2014) Cognitive conflicts in major depression: between desired change and personal coherence. British Journal of Clinical Psychology 53, 369–385.Google Scholar
Ferrari, A, Somerville, A, Baxter, A, Norman, R, Patten, S, Vos, T and Whiteford, H (2013 a) Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature. Psychological Medicine 43, 471–481.Google Scholar
Ferrari, AJ, Charlson, FJ, Norman, RE, Patten, SB, Freedman, G, Murray, CJ, Vos, T and Whiteford, HA (2013 b) Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Medicine 10, e1001547.Google Scholar
Fiedorowicz, JG, Leon, AC, Keller, MB, Solomon, DA, Rice, JP and Coryell, WH (2009) Do risk factors for suicidal behavior differ by affective disorder polarity? Psychological Medicine 39, 763–771.Google Scholar
Friedman, S, Smith, L and Fogel, D (1999) Suicidality in panic disorder: a comparison with schizophrenic, depressed, and other anxiety disorder outpatients. Journal of Anxiety Disorders 13, 447–461.Google Scholar
Gonzalez, VM (2008) Recognition of mental illness and suicidality among individuals with serious mental illness. Journal of Nervous and Mental Disease 196, 727–734.Google Scholar
Gonzalez-Castro, TB, Tovilla-Zarate, C, Juarez-Rojop, I, Pool Garcia, S, Velazquez-Sanchez, MP, Genis, A, Nicolini, H and Lopez Narvaez, L (2013) Association of the 5HTR2A gene with suicidal behavior: case-control study and updated meta-analysis. BioMed Central Psychiatry 13, 25.Google Scholar
Gournellis, R, Tournikioti, K, Touloumi, G, Thomadakis, C, Michalopoulou, PG, Christodoulou, C, Papadopoulou, A and Douzenis, A (2017) Psychotic (delusional) depression and suicidal attempts: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica 137, 18–29.Google Scholar
Griffiths, KM, Christensen, H and Jorm, AF (2008) Predictors of depression stigma. BioMed Central Psychiatry 8, 25.Google Scholar
Grunebaum, MF, Keilp, J, Li, SH, Ellis, SP, Burke, AK, Oquendo, MA and Mann, JJ (2005) Symptom components of standard depression scales and past suicidal behavior. Journal of Affective Disorders 87, 73–82.Google Scholar
Grunebaum, MF, Galfalvy, HC, Mortenson, LY, Burke, AK, Oquendo, MA and Mann, JJ (2010) Attachment and social adjustment: relationships to suicide attempt and major depressive episode in a prospective study. Journal of Affective Disorders 123, 123–130.Google Scholar
Harris, EC and Barraclough, B (1997) Suicide as an outcome for mental disorders. A meta-analysis. British Journal of Psychiatry 170, 205–228.Google Scholar
Hawton, K, Comabella, CCI, Haw, C and Saunders, K (2013) Risk factors for suicide in individuals with depression: a systematic review. Journal of Affective Disorders 147, 17–28.Google Scholar
Hegerl, U, Mergl, R, Quail, D, Schneider, E, Strauss, M, Hundemer, HP and Linden, M (2013) Fast versus slow onset of depressive episodes: a clinical criterion for subtyping patients with major depression. European Psychiatry 28, 288–292.Google Scholar
Henriksson, MM, Aro, HM, Marttunen, MJ, Heikkinen, ME, Isometsa, E, Kuoppasalmi, KI and Lonnqvist, J (1993) Mental disorders and comorbidity in suicide. American Journal of Psychiatry 150, 935–935.Google Scholar
Higgins, JP, Thompson, SG, Deeks, JJ and Altman, DG (2003) Measuring inconsistency in meta-analyses. British Medical Journal 327, 557.Google Scholar
Hofer, P, Schosser, A, Calati, R, Serretti, A, Massat, I, Kocabas, NA, Konstantinidis, A, Mendlewicz, J, Souery, D, Zohar, J, Juven-Wetzler, A, Montgomery, S and Kasper, S (2016) The impact of serotonin receptor 1A and 2A gene polymorphisms and interactions on suicide attempt and suicide risk in depressed patients with insufficient response to treatment – a European multicentre study. International Clinical Psychopharmacology 31, 1–7.Google Scholar
Holma, KM, Melartin, TK, Haukka, J, Holma, IA, Sokero, TP and Isometsä, ET (2010) Incidence and predictors of suicide attempts in DSM–IV major depressive disorder: a five-year prospective study. American Journal of Psychiatry 167, 801–808.Google Scholar
Hovanesian, S, Isakov, I and Cervellione, KL (2009) Defense mechanisms and suicide risk in major depression. Archives of Suicide Research 13, 74–86.Google Scholar
Isometsa, ET and Lonnqvist, JK (1998) Suicide attempts preceding completed suicide. British Journal of Psychiatry 173, 531–535.Google Scholar
Izci, F, Zincir, S, Zincir, SB, Bilici, R, Gica, S, Koc, MSI, Goncu, T, Terzi, A and Semiz, UB (2015) Suicide attempt, suicidal ideation and hopelessness levels in major depressive patients with and without alexithymia. Dusunen Adam 28, 27–33.Google Scholar
Jandl, M, Steyer, J and Kaschka, WP (2010) Suicide risk markers in major depressive disorder: a study of electrodermal activity and event-related potentials. Journal of Affective Disorders 123, 138–149.Google Scholar
Jeon, HJ, Park, JI, Fava, M, Mischoulon, D, Sohn, JH, Seong, S, Park, JE, Yoo, I and Cho, MJ (2014) Feelings of worthlessness, traumatic experience, and their comorbidity in relation to lifetime suicide attempt in community adults with major depressive disorder. Journal of Affective Disorders 166, 206–212.Google Scholar
Kang, HJ, Kim, JM, Lee, JY, Kim, SY, Bae, KY, Kim, SW, Shin, IS, Kim, HR, Shin, MG and Yoon, JS (2013) BDNF promoter methylation and suicidal behavior in depressive patients. Journal of Affective Disorders 151, 679–685.Google Scholar
Kao, Y-C, Liu, Y-P, Cheng, T-H and Chou, M-K (2012) Subjective quality of life and suicidal behavior among Taiwanese schizophrenia patients. Social Psychiatry and Psychiatric Epidemiology 47, 523–532.Google Scholar
Keilp, JG, Gorlyn, M, Oquendo, MA, Brodsky, B, Ellis, SP, Stanley, B and John Mann, J (2006) Aggressiveness, not impulsiveness or hostility, distinguishes suicide attempters with major depression. Psychological Medicine 36, 1779–1788.Google Scholar
Kessler, RC, Borges, G and Walters, EE (1999) Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry 56, 617–626.Google Scholar
Kim, S-W, Stewart, R, Kim, J-M, Shin, S II, Yoon, J-S, Jung, S-W, Lee, M-S, Yim, H-W and Jun, T-Y (2011) Relationship between a history of a suicide attempt and treatment outcomes in patients with depression. Journal of Clinical Psychopharmacology 31, 449–456.Google Scholar
Li, K, Wei, Q, Li, G, He, X, Liao, Y and Gan, Z (2016) Time to lack of persistence with pharmacological treatment among patients with current depressive episodes: a natural study with 1-year follow-up. Patient Preference and Adherence 10, 2209–2215.Google Scholar
Linkowski, P, de Maertelaer, V and Mendlewicz, J (1985) Suicidal behaviour in major depressive illness. Acta Psychiatrica Scandinavica 72, 233–238.Google Scholar
Long, J, Huang, G, Liang, W, Liang, B, Chen, Q, Xie, J, Jiang, J and Su, L (2014) The prevalence of schizophrenia in mainland China: evidence from epidemiological surveys. Acta Psychiatrica Scandinavica 130, 244–256.Google Scholar
Low, W, Azmi, S, Li, Y, Yee, SL, Abdat, A, Kalita, P, Ge, L and Milea, D (2014) Prevalence of major depressive disorder in China. Value in Health 17, A767.Google Scholar
Maj, M, Pirozzi, R, Magliano, L, Fiorillo, A and Bartoli, L (2007) Phenomenology and prognostic significance of delusions in major depressive disorder: a 10-year prospective follow-up. The Journal of Clinical Psychiatry 68, 1411–1417.Google Scholar
McHolm, AE, MacMillan, HL and Jamieson, E (2003) The relationship between childhood physical abuse and suicidality among depressed women: results from a community sample. American Journal of Psychiatry 160, 933–938.Google Scholar
Min, JA, Lee, SH, Lee, SY, Chae, JH, Lee, CU, Park, YM and Bae, SM (2012) Clinical characteristics associated with different strengths of loudness dependence of auditory evoked potentials (LDAEP) in major depressive disorder. Psychiatry Research 200, 374–381.Google Scholar
Mitchell, PB, Frankland, A, Hadzi-Pavlovic, D, Roberts, G, Corry, J, Wright, A, Loo, CK and Breakspear, M (2011) Comparison of depressive episodes in bipolar disorder and in major depressive disorder within bipolar disorder pedigrees. British Journal of Psychiatry 199, 303–309.Google Scholar
Mugisha, J, Muyinda, H, Malamba, S and Kinyanda, E (2015) Major depressive disorder seven years after the conflict in northern Uganda: burden, risk factors and impact on outcomes (The Wayo-Nero Study). BioMed Central Psychiatry 15, 48.Google Scholar
Nam, YY, Kim, CH and Roh, D (2016) Comorbid panic disorder as an independent risk factor for suicide attempts in depressed outpatients. Comprehensive Psychiatry 67, 13–18.Google Scholar
Nepon, J, Belik, SL, Bolton, J and Sareen, J (2010) The relationship between anxiety disorders and suicide attempts: findings from the national epidemiologic survey on alcohol and related conditions. Depression and Anxiety 27, 791–798.Google Scholar
Nock, MK, Borges, G, Bromet, EJ, Alonso, J, Angermeyer, M, Beautrais, A, Bruffaerts, R, Chiu, WT, De Girolamo, G and Gluzman, S (2008) Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry 192, 98–105.Google Scholar
Nock, MK, Hwang, I, Sampson, NA and Kessler, RC (2010) Mental disorders, comorbidity and suicidal behavior: results from the national comorbidity survey replication. Molecular Psychiatry 15, 868.Google Scholar
Nordentoft, M and Mortensen, PB (2011) Absolute risk of suicide after first hospital contact in mental disorder. Archives of General Psychiatry 68, 1058–1064.Google Scholar
O'Donovan, A, Rush, G, Hoatam, G, Hughes, BM, McCrohan, A, Kelleher, C, O'Farrelly, C and Malone, KM (2013) Suicidal ideation is associated with elevated inflammation in patients with major depressive disorder. Depression and Anxiety 30, 307–314.Google Scholar
Oedegaard, KJ, Neckelmann, D, Benazzi, F, Syrstad, VE, Akiskal, HS and Fasmer, OB (2008) Dissociative experiences differentiate bipolar-II from unipolar depressed patients: the mediating role of cyclothymia and the Type A behaviour speed and impatience subscale. Journal of Affective Disorders 108, 207–216.Google Scholar
Oquendo, MA, Galfalvy, H, Russo, S, Ellis, SP, Grunebaum, MF, Burke, A and Mann, JJ (2004) Prospective study of clinical predictors of suicidal acts after a major depressive episode in patients with major depressive disorder or bipolar disorder. American Journal of Psychiatry 161, 1433–1441.Google Scholar
Osváth, P, Kelemen, G, Erdös, MB, Vörös, V and Fekete, S (2003) The main factors of repetition: review of some results of the Pecs Center in the WHO/EURO multicentre study on suicidal behaviour. Crisis: Journal of Crisis Intervention and Suicide Prevention 24, 151.Google Scholar
Ozer, U, Yildirim, EA and Erkoc, SN (2015) Relationship of suicidal ideation and behavior to attachment style in patients with major depression. Noro Psikiyatri Arsivi 52, 283–288.Google Scholar
Park, YM, Ko, YH, Lee, MS, Lee, HJ and Kim, L (2014) Type-d personality can predict suicidality in patients with major depressive disorder. Psychiatry Investigation 11, 232–236.Google Scholar
Park, EH, Hong, N, Jon, DI, Hong, HJ and Jung, MH (2017) Past suicidal ideation as an independent risk factor for suicide behaviours in patients with depression. International Journal of Psychiatry in Clinical Practice 21, 24–28.Google Scholar
Pawlak, J, Dmitrzak-Weglarz, M, Wilkosc, M, Szczepankiewicz, A, Leszczynska-Rodziewicz, A, Zaremba, D, Kapelski, P, Rajewska-Rager, A and Hauser, J (2016) Suicide behavior as a quantitative trait and its genetic background. Journal of Affective Disorders 206, 241–250.Google Scholar
Peng, HJ, Wu, K, Li, J, Qi, HC, Guo, SW, Chi, MY, Wu, XM, Guo, YB, Yang, YL and Ning, YP (2014) Increased suicide attempts in young depressed patients with abnormal temporal-parietal-limbic gray matter volume. Journal of Affective Disorders 165, 69–73.Google Scholar
Phillips, MR, Yang, G, Zhang, Y, Wang, L, Ji, H and Zhou, M (2002) Risk factors for suicide in China: a national case-control psychological autopsy study. Lancet 360, 1728–1736.Google Scholar
Pompili, M, Gibiino, S, Innamorati, M, Serafini, G, Del Casale, A, De Risio, L, Palermo, M, Montebovi, F, Campi, S, De Luca, V, Sher, L, Tatarelli, R, Biondi, M, Duval, F, Serretti, A and Girardi, P (2012) Prolactin and thyroid hormone levels are associated with suicide attempts in psychiatric patients. Psychiatry Research 200, 389–394.Google Scholar
Posner, K, Oquendo, MA, Gould, M, Stanley, B and Davies, M (2007) Columbia classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants. American Journal of Psychiatry 164, 1035–1043.Google Scholar
Rihmer, Z and Kiss, K (2002) Bipolar disorders and suicidal behaviour. Bipolar Disorders 4, 21–25.Google Scholar
Riihimaki, K, Vuorilehto, M, Melartin, T, Haukka, J and Isometsa, E (2014) Incidence and predictors of suicide attempts among primary-care patients with depressive disorders: a 5-year prospective study. Psychological Medicine 44, 291–302.Google Scholar
Seo, HJ, Jung, YE, Jeong, S, Kim, JB, Lee, MS, Kim, JM, Yim, HW and Jun, TY (2014) Personality traits associated with suicidal behaviors in patients with depression: the CRESCEND study. Comprehensive Psychiatry 55, 1085–1092.Google Scholar
Serafini, G, Pompili, M, Innamorati, M, Fusar-Poli, P, Akiskal, HS, Rihmer, Z, Lester, D, Romano, A, de Oliveira, IR, Strusi, L, Ferracuti, S, Girardi, P and Tatarelli, R (2011) Affective temperamental profiles are associated with white matter hyperintensity and suicidal risk in patients with mood disorders. Journal of Affective Disorders 129, 47–55.Google Scholar
Sher, L (2006) Risk and protective factors for suicide in patients with alcoholism. The Scientific World Journal 6, 1405–1411.Google Scholar
Sher, L, Mann, JJ, Traskman-Bendz, L, Winchel, R, Huang, YY, Fertuck, E and Stanley, BH (2006) Lower cerebrospinal fluid homovanillic acid levels in depressed suicide attempters. Journal of Affective Disorders 90, 83–89.Google Scholar
Shibre, T, Hanlon, C, Medhin, G, Alem, A, Kebede, D, Teferra, S, Kullgren, G, Jacobsson, L and Fekadu, A (2014) Suicide and suicide attempts in people with severe mental disorders in Butajira, Ethiopia: 10 year follow-up of a population-based cohort. BioMed Central Psychiatry 14, 150.Google Scholar
Sokero, TP, Melartin, TK, Rytsala, HJ, Leskela, US, Lestela-Mielonen, PS and Isometsa, ET (2005) Prospective study of risk factors for attempted suicide among patients with DSM-IV major depressive disorder. British Journal of Psychiatry 186, 314–318.Google Scholar
Souery, D, Oswald, P, Massat, I, Bailer, U, Bollen, J, Demyttenaere, K, Kasper, S, Lecrubier, Y, Montgomery, S and Serretti, A (2007) Clinical factors associated with treatment resistance in major depressive disorder: results from a European multicenter study. Journal of Clinical Psychiatry 68, 1062–1070.Google Scholar
Spalletta, G, Troisi, A, Saracco, M, Ciani, N and Pasini, A (1996) Symptom profile, Axis II comorbidity and suicidal behaviour in young males with DSM-II-R depressive illnesses. Journal of Affective Disorders 39, 141–148.Google Scholar
Spitzer, RL, Endicott, J and Robins, E (1978) Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.Google Scholar
Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D, Moher, D, Becker, BJ, Sipe, TA and Thacker, SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Journal of American Medical Association 283, 2008–2012.Google Scholar
Su, MH, Chen, HC, Lu, ML, Feng, J, Chen, IM, Wu, CS, Chang, SW and Kuo, PH (2018) Risk profiles of personality traits for suicidality among mood disorder patients and community controls. Acta Psychiatrica Scandinavica 137, 30–38.Google Scholar
Sublette, ME, Galfalvy, HC, Fuchs, D, Lapidus, M, Grunebaum, MF, Oquendo, MA, Mann, JJ and Postolache, TT (2011) Plasma kynurenine levels are elevated in suicide attempters with major depressive disorder. Brain, Behavior, and Immunity 25, 1272–1278.Google Scholar
Subramaniam, M, Abdin, E, Seow, EL, Picco, L, Vaingankar, JA and Chong, SA (2014) Suicidal ideation, suicidal plan and suicidal attempts among those with major depressive disorder. Annals of the Academy of Medicine, Singapore 43, 412–421.Google Scholar
Sudol, K and Mann, JJ (2017) Biomarkers of suicide attempt behavior: towards a biological model of risk. Current Psychiatry Reports 19, 31.Google Scholar
Suominen, K, Isometsä, E, Suokas, J, Haukka, J, Achte, K and Lönnqvist, J (2004) Completed suicide after a suicide attempt: a 37-year follow-up study. American Journal of Psychiatry 161, 562–563.Google Scholar
Tsujii, N, Akashi, H, Mikawa, W, Tsujimoto, E, Niwa, A, Adachi, T and Shirakawa, O (2014) Discrepancy between self- and observer-rated depression severities as a predictor of vulnerability to suicide in patients with mild depression. Journal of Affective Disorders 161, 144–149.Google Scholar
van Noorden, MS, Minkenberg, SE, Giltay, EJ, den Hollander-Gijsman, ME, van Rood, YR, van der Wee, NJ and Zitman, FG (2011) Pre-adult versus adult onset major depressive disorder in a naturalistic patient sample: the Leiden Routine Outcome Monitoring Study. Psychological Medicine 41, 1407–1417.Google Scholar
Vickers, K and McNally, RJ (2004) Panic disorder and suicide attempt in the National Comorbidity Survey. Journal of Abnormal Psychology 113, 582.Google Scholar
Vijayakumar, L (2004) Suicide prevention: the urgent need in developing countries. World Psychiatry 3, 158–159.Google Scholar
Von Elm, E, Altman, DG, Egger, M, Pocock, SJ, Gøtzsche, PC, Vandenbroucke, JP and Initiative, S (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Medicine 4, e296.Google Scholar
Wakefield, JC and Schmitz, MF (2016) Feelings of worthlessness during a single complicated major depressive episode predict postremission suicide attempt. Acta Psychiatrica Scandinavica 133, 257–265.Google Scholar
Wan, Y, Hu, Q, Li, T, Jiang, L, Du, Y, Feng, L, Wong, JC-M and Li, C (2013) Prevalence of autism spectrum disorders among children in China: a systematic review. Shanghai Archives of Psychiatry 25, 70.Google Scholar
Wang, S, Zhang, K, Xu, Y, Sun, N, Shen, Y and Xu, Q (2009) An association study of the serotonin transporter and receptor genes with the suicidal ideation of major depression in a Chinese Han population. Psychiatry Research 170, 204–207.Google Scholar
Wei, SN, Li, HY, Hou, JL, Chen, W, Chen, X and Qin, XX (2017) Comparison of the characteristics of suicide attempters with major depressive disorder and those with no psychiatric diagnosis in emergency departments of general hospitals in China. Annals of General Psychiatry 16, 44.Google Scholar
WHO (2015) Suicide data. Available at http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/.Google Scholar
Winsper, C, Ganapathy, R, Marwaha, S, Large, M, Birchwood, M and Singh, S (2013) A systematic review and meta-regression analysis of aggression during the First Episode of Psychosis. Acta Psychiatrica Scandinavica 128, 413–421.Google Scholar
Witte, TK, Timmons, KA, Fink, E, Smith, AR and Joiner, TE (2009) Do major depressive disorder and dysthymic disorder confer differential risk for suicide? Journal of Affective Disorders 115, 69–78.Google Scholar
Worldbank (2017) New country classifications by income level: 2017–2018. Available at databank.worldbank.org/data/download/site-content/CLASS.xls.Google Scholar
Yeh, YW, Ho, PS, Chen, CY, Kuo, SC, Liang, CS, Ma, KH, Shiue, CY, Huang, WS, Cheng, CY, Wang, TY, Lu, RB and Huang, SY (2015) Incongruent reduction of serotonin transporter associated with suicide attempts in patients with major depressive disorder: a positron emission tomography study with 4-[F-18]-ADAM. International Journal of Neuropsychopharmacology 18, 1–9.Google Scholar
Yenilmez, E, Kumsar, NA, Kütük, EK and Dilbaz, N (2014) Comparison between clinical features and residual depressive symptoms of patients with bipolar depressive and unipolar depressive disorder in remission. African Journal of Psychiatry (South Africa) 17, 119.Google Scholar
Yoshimasu, K, Kiyohara, C and Miyashita, K (2008) Suicidal risk factors and completed suicide: meta-analyses based on psychological autopsy studies. Environmental health and preventive medicine 13, 243.Google Scholar
Zayas, L, Gulbas, LE, Fedoravicius, N and Cabassa, LJ (2010) Patterns of distress, precipitating events, and reflections on suicide attempts by young Latinas. Social Science and Medicine 70, 1773–1779.Google Scholar
Zeng, R, Cohen, LJ, Tanis, T, Qizilbash, A, Lopatyuk, Y, Yaseen, ZS and Galynker, I (2015) Assessing the contribution of borderline personality disorder and features to suicide risk in psychiatric inpatients with bipolar disorder, major depression and schizoaffective disorder. Psychiatry Research 226, 361–367.Google Scholar
Zhu, Y, Zhang, H, Shi, S, Gao, J, Li, Y, Tao, M, Zhang, K, Wang, X, Gao, C, Yang, L, Li, K, Shi, J, Wang, G, Liu, L, Zhang, J, Du, B, Jiang, G, Shen, J, Zhang, Z, Liang, W, Sun, J, Hu, J, Liu, T, Wang, X, Miao, G, Meng, H, Li, Y, Hu, C, Li, Y, Huang, G, Li, G, Ha, B, Deng, H, Mei, Q, Zhong, H, Gao, S, Sang, H, Zhang, Y, Fang, X, Yu, F, Yang, D, Liu, T, Chen, Y, Hong, X, Wu, W, Chen, G, Cai, M, Song, Y, Pan, J, Dong, J, Pan, R, Zhang, W, Shen, Z, Liu, Z, Gu, D, Wang, X, Liu, X, Zhang, Q, Li, Y, Chen, Y, Kendler, KS, Flint, J and Liu, Y (2013) Suicidal risk factors of recurrent major depression in Han Chinese women. PLoS One 8, e80030.Google Scholar
Zisook, S, Goff, A, Sledge, P and Shuchter, SR (1994) Reported suicidal behavior and current suicidal ideation in a psychiatric outpatient clinic. Annals of Clinical Psychiatry 6, 27–31.Google Scholar
Zlotnick, C, Mattia, J and Zimmerman, M (2001) Clinical features of survivors of sexual abuse with major depression. Child Abuse and Neglect 25, 357–367.Google Scholar