Depressive Episodes with Suicide Attempts in Severe Depression: Suicides and Controls Differ Only in the Later Episodes of Unipolar Depression

The aim of the present study was to investigate the distribution of suicide attempts across the depressive episodes in suicides and controls with a severe depression. A blind record evaluation was performed of 100 suicide victims and matched controls admitted to the Department of Psychiatry between 1956 and 1969 and monitored to 2006. There was a similar number of episodes in suicides and controls and in the early episodes a similar number of suicide attempts in both groups. However, in the later episodes future suicides showed more suicide attempts as compared to controls. This was found for unipolar depression only. This difference was found despite previously shown similar rates of adequate treatment and improvement. In conclusion, more depressive episodes including suicide attempts appeared to be related to suicide.