Citation

Bradvik L, Berglund M. BMC Psychiatry 2011; 11(1): 5.

Copyright

(Copyright © 2011, Holtzbrinck Springer Nature Publishing Group - BMC)

DOI

10.1186/1471-244X-11-5

PMID

21214896

PMCID

PMC3023739

Abstract

BACKGROUND: Depressed suicide victims are known to have made more suicide attempts during their life-span as compared to living depressives. A behavioral sensitization or kindling model has been proposed for suicidal behavior, in accordance with a sensitization model of depressive episodes. The aim of the present study was to test such a model by investigating the distribution of initial and repeated suicide attempts across the episodes in suicides and controls with a unipolar severe depression. METHOD: A blind record evaluation was performed of 80 suicide victims and controls admitted to the Department of Psychiatry between 1956 and 1969 and monitored to 2006. The occurrence of initial and repeated suicide attempts by order of the depressive episodes was compared for suicides and controls. RESULTS: The risk of a first suicide attempt decreased throughout the later episodes of depression in both suicides (p< .000) and controls (p< .000). The frequencies of repetition early in the course were actually higher in the control group (p< .007). After that, the risk decreased in the control group, while the frequencies remained proportional in the suicide group. At the same time, there was a significantly greater decreased risk of repeated attempts during later episodes in the control group as compared to the suicide group (p< .000). The differences were found despite a similar number of episodes in suicides and controls. Moreover, similar rates of adequate treatment of the episodes in suicides and controls have previously been found. Conclusion: Repeated suicide attempts in the later episodes of depression appear to be a risk factor for suicide in severe depression. This finding is compatible with a behavioral sensitization of attempts across the depressive episodes, which seemed to be independent of a corresponding kindling of depression.

Language: en