Predictors of suicidality in depressive spectrum disorders in the general population: results of the Netherlands Mental Health Survey and Incidence Study

Abstract

The aim was to assess determinants of suicidality (suicidal ideation and suicide attempts) in a general population cohort with depressive spectrum disorders, and to compare determinants for suicidal ideation and determinants for suicide attempts in this cohort. The Netherlands Mental Health Survey and Incidence Study is a epidemiologic survey in the adult population (N = 7,076), using the Composite International Diagnostic Interview (CIDI). In a cohort of 586 persons with a depressive spectrum disorder, 97 (16.6%) reported suicidal ideation and 19 (3.2%) suicide attempts in a period of 2 years. In a multivariate model, male gender (OR 0.54, 95% CI 0.30-0.99, p = 0.05), longer (> 13 months) duration of depression (OR 2.86, 95%CI 1.21-6.73, p = 0.02; OR 2.71, 95% CI 1.24-5.91, p = 0.01), anhedonia (OR 2.00, 95% CI 1.01-5.91, p = 0.05), feeling worthless (OR 1.99, 95% CI 1.05-3.74, p = 0.03), comorbid anxiety (OR 2.46, 95% CI 1.38-4.40, p < 0.01), previous suicidal ideation (OR 3.50, 95% CI 1.96-6.24, p < 0.001) and use of professional care (OR 1.96, 95% CI 1.01-3.79, p = 0.05) were significantly related to suicidality. Determinants of suicidal ideation differed from determinants of suicide attempts. Suicidality (and not actual suicides) was assessed with only two questions from the CIDI and some determinants for suicidality were assessed in the same time period as suicidality. Features of depression were the most important determinants of suicidality in a depressive spectrum cohort. Determinants for suicidal ideation differed from suicide attempts. These findings could be helpful in identifying those who need more intense treatment strategies in order to prevent suicidality and eventually suicide.