The study aims to establish the predictive value of a diagnosis of depression among elderly according to the 10th revision of the International Statistical Classification of Diseases (ICD-10) by measuring morbidity, medication usage, health service utilization and mortality during an 8-year follow-up of depressed elderly inpatients (n=76) and community-living depressed patients (n=38) compared with controls (n=116). The data were taken from GPs' medical records and health statistics registers. At baseline, no significant differences were observed between the two cohorts of depressed patients and the controls in terms of prevalence of cardiovascular, respiratory or cerebrovascular morbidity. During follow-up, both cohorts of depressed patients had significantly increased rates of recurrent depressions, consumption of antidepressants, psychiatric in- and outpatient admissions, and home visits; inpatients used more psychiatric hospital days. Health service utilization in somatic hospitals and somatic diagnoses was not significantly increased. Inpatients used significantly fewer GP office-hour services but more out-of-hours services than the control group. Community-living depressed patients experienced no significant increase in use of GP services. Survival was unaffected in both cohorts. In agreement with other studies, especially inpatient depression predicted increased rates of recurrent depressions and increased use of psychiatric hospital services, indicating poor long-term outcome. Inpatients consumed fewer GP office-hour services but more out-of-hours services, possibly due to less office-hour contact. Contrasting with other studies, ICD-10 depression among elderly predicted no increase in the use of somatic hospital facilities.
We investigated the association between unipolar depression and incident hospital admissions due to ischemic heart disease, invasive cardiac procedures and mortality independent of other medical illnesses.
A population-based cohort of 4.6 million persons aged 15 years or older and born in Denmark was followed up from 1995-2009. Incidence rate ratio (IRR) and mortality rate ratio (MRR) were estimated by survival analysis, stratified by or adjusted for gender, age, severe chronic somatic comorbidity and calendar time.
Adjusted risks of cardiac hospital admissions and death were significantly increased by up to 15% and 68%, respectively, in persons with hospital admissions due to depression, and were most increased in 15-59 year old women (IRR: 1.64; MRR: 2.57) and men with depression (IRR: 1.39; MRR: 2.21), and during the first 180 days after being diagnosed with depression (women: IRR: 1.38; MRR: 2.35; men: IRR: 1.42; MRR: 2.67). One-year mortality after new ischemic heart disease was elevated by 34% in women and men. By contrast, overall rates of invasive cardiac procedures following cardiac hospitalizations were significantly decreased by 34% in persons with depression but were twofold increased in men recently diagnosed with depression.
Clinical depression leading to hospitalization was a risk factor for new cardiac complications independent of somatic comorbidity in the magnitude of other cardiac risk factors, particularly in individuals between 15-59 years of age and during the first weeks following psychiatric admission. Our findings support recent cardiovascular disease prevention guidelines on assessing depression among other psychosocial factors in patients at increased cardiovascular disease (CVD) risk.
Patients with affective disorders are at high risk of suicide, especially during inpatient treatment and during the first year after discharge.
A blinded case-control design was used. The study included a total national sample of patients with affective disorder admitted during the period from January 1, 1994 to December 31, 1995, who died because of suicide, either during admission or shortly after discharge.
A history of suicide attempt was a significant risk factor (IRR 4.9; 95% CI 2.1-11.6). Loss of job during the year prior to the index admission was associated with an increase in suicide risk (IRR: 2.9; 95% CI 1.2-7.5). Clinical improvement during the index admission (IRR: 0.3; 95% CI 0.1-0.7), and treatment with antidepressant drugs at the censoring date (IRR: 0.3; 95% CI 0.1-0.7) were associated with a decrease in suicide risk.
Improved treatment may be a key factor in suicide prevention in patients during, and shortly after hospitalisation with affective disorders. Also, there is a need to be especially aware of suicide risk in patients with little or no improvement at discharge.
BACKGROUND: Seasonal spring peaks of suicide are highly replicated, but their origin is poorly understood. As the peak of suicide in spring could be a consequence of decompensation of mood disorders in spring, we hypothesized that prior history of mood disorders is predictively associated with suicide in spring. METHODS: We analyzed the monthly rates of suicide based upon all 37,987 suicide cases in the Danish Cause of Death Registry from 1970 to 2001. History of mood disorder was obtained from the Danish Psychiatric Central Register and socioeconomical data from the Integrated Database for Labour Market Research. The monthly rate ratio of suicide relative to December was estimated using a Poisson regression. Seasonality of suicide between individuals with versus without hospitalization for mood disorders was compared using conditional logistic regression analyses with adjustment for income, marital status, place of residence, and method of suicide. RESULTS: A statistically significant spring peak in suicide was observed in both groups. A history of mood disorders was associated with an increased risk of suicide in spring (for males: RR=1.18, 95% CI 1.07-1.31; for females: RR=1.20, 95% CI 1.10-1.32). LIMITATIONS: History of axis II disorders was not analyzed. Danish socioeconomical realities have only limited generalizability. CONCLUSIONS: The results support the need to further investigate if exacerbation of mood disorders in spring triggers seasonal peaks of suicide. Identifying triggers for seasonal spring peaks in suicide may lead to uncovering novel risk factors and therapeutic targets for suicide prevention.
About one-half to two-thirds of all suicides are by people who suffer from mood disorders; preventing suicides among those who suffer from them is thus central for suicide prevention. Understanding factors underlying suicide risk is necessary for rational preventive decisions.
The literature on risk factors for completed and attempted suicide among subjects with depressive and bipolar disorders (BDs) was reviewed.
Lifetime risk of completed suicide among psychiatric patients with mood disorders is likely between 5% and 6%, with BDs, and possibly somewhat higher risk than patients with major depressive disorder. Longitudinal and psychological autopsy studies indicate suicidal acts usually take place during major depressive episodes (MDEs) or mixed illness episodes. Incidence of suicide attempts is about 20- to 40-fold, compared with euthymia, during these episodes, and duration of these high-risk states is therefore an important determinant of overall risk. Substance use and cluster B personality disorders also markedly increase risk of suicidal acts during mood episodes. Other major risk factors include hopelessness and presence of impulsive-aggressive traits. Both childhood adversity and recent adverse life events are likely to increase risk of suicide attempts, and suicidal acts are predicted by poor perceived social support. Understanding suicidal thinking and decision making is necessary for advancing treatment and prevention.
Among subjects with mood disorders, suicidal acts usually occur during MDEs or mixed episodes concurrent with comorbid disorders. Nevertheless, illness factors can only in part explain suicidal behaviour. Illness factors, difficulty controlling impulsive and aggressive responses, plus predisposing early exposures and life situations result in a process of suicidal thinking, planning, and acts.
Cites: Am J Psychiatry. 2010 Jul;167(7):801-820478879