Suicide—completed and attempted—represents a major clinical and
public health challenge. The CDC has ranked suicide as the 11th
leading cause of death among persons over age 10 (33,289 suicide
deaths were reported in the United States in 2009, and this rate
has been stable for many years).1 About 90% of suicides occur in
persons with a clinically diagnosable psychiatric disorder.2-4
The standardized mortality risk ratio is higher for patients
with major mood disorders than for the general population. For
patients with unipolar major depressive disorder (UP-MDD),
standardized mortality ratios show a 20-fold increase over the
general population of patients with bipolar disorder (BPD) or
depression who have ever been hospitalized.2,5 Suicide risk in
patients with UP-MDD is strongly related to illness severity.
Patients who have been hospitalized with UP-MDD are at greater
risk than those treated as outpatients: higher depression-rating
scores further boost the risk and support the view that current
depressed moo