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Sex Difference Seen in Risk Factors for Suicide
After Depression
NEW YORK (Reuters Health) Jan 18 - Clinical predictors of
suicidal acts after major depression differ between men and women,
according to study findings published in the January issue of the
American Journal of Psychiatry.
"Sex differences in suicidal behavior have long been recognized,"
Dr. Maria A. Oquendo, of Columbia University, New York, and
colleagues write. "Studies have shown that men have higher suicide
rates, while women are at higher risk for suicide attempts," they
note.
The researchers examined whether there are differences between
men and women in clinical risk factors associated with suicidal
behavior in a study involving 184 women and 130 men with major
depression or bipolar disorder seeking treatment for a major
depressive episode. The patients were evaluated 3 months, 1 year,
and 2 years after discharge.
Cox proportional hazards regression analysis was used to test
putative predictors. The team hypothesized that aggression,
hostility, and history of substance misuse would increase the risk
for future suicidal behavior among men, while depressive symptoms,
childhood history of abuse, fewer reasons for living, and borderline
personality disorder would increase the risk in depressed women.
Overall, four subjects completed suicide and 48 attempted suicide
during follow-up. This represented 16.6% of the cohort. Women were
more likely than men to attempt suicide in the follow-up period
(hazard ratio = 1.8, p < 0.05).
For men, a previous suicide attempt, family history of suicidal
acts, past drug use, cigarette smoking, borderline personality
disorder, and early parental separation increased the risk of a
future suicidal act by at least threefold.
For women, the risk of a future suicide attempt was six times
greater among those who had made a prior attempt. Each prior attempt
increased the future risk threefold. The risk of future suicidal
acts for women was also increased by suicidal ideation, lethality of
past attempts, hostility, subjective depressive symptoms, fewer
reasons for living, comorbid borderline personality disorder, and
cigarette smoking.
"When all significant predictors of suicidal acts for men
identified by univariate analyses were evaluated together, cigarette
smoking and family history of suicidal acts emerged as the most
robust predictors of future suicidal acts, but early separation from
family, borderline personality disorder, and past drug abuse were no
longer predictive," Dr. Oquendo and colleagues explain.
"For women, the multivariate analyses revealed that previous
attempts, suicidal ideation, and smoking had independent effects on
the risk for suicidal acts," they note. "The presence of multiple
suicide attempts, borderline personality disorder, greater
subjective depression, fewer perceived reasons for living, and
hostility were no longer significant."
The researchers conclude, this knowledge may improve suicide risk
evaluation and guide future research on suicide assessment and
prevention."
Am J Psychiatry 2007;164:134-141.
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