Seventy-five patients were admitted to the ward of the Lund Suicide Research Center following a suicide attempt. After 5 years, the patients were followed up by a personal semistructured interview covering sociodemographic, psychosocial and psychiatric areas. Ten patients (13%) had committed suicide during the follow-up period, the majority within 2 years. They tended to be older at the index attempt admission, and most of them had a mood disorder in comparison with the others. Two patients had died from somatic diseases. Forty-two patients were interviewed, of whom 17 (40%) had reattempted during the follow-up period, most of them within 3 years. Predictors for reattempt were young age, personality disorder, parents having received treatment for psychiatric disorder, and a poor social network. At the index attempt, none of the reattempters had diagnoses of adjustment disorders or anxiety disorders. At follow-up, reattempters had more psychiatric symptoms (SCL-90), and their overall functioning (GAF) was poor compared to those who did not reattempt. All of the reattempters had long-lasting treatment ( > 3 years) as compared to 56% of the others. It is of great clinical importance to focus on treatment strategies for the vulnerable subgroup of self-destructive reattempters.
The aim of the present study was to investigate the distribution of suicide attempts across the depressive episodes in suicides and controls with a severe depression. A blind record evaluation was performed of 100 suicide victims and matched controls admitted to the Department of Psychiatry between 1956 and 1969 and monitored to 2006. There was a similar number of episodes in suicides and controls and in the early episodes a similar number of suicide attempts in both groups. However, in the later episodes future suicides showed more suicide attempts as compared to controls. This was found for unipolar depression only. This difference was found despite previously shown similar rates of adequate treatment and improvement. In conclusion, more depressive episodes including suicide attempts appeared to be related to suicide.
The 5-year prognosis for 264 depressed elderly Finns (60 years or older) living in the community and treated through the primary health care service is described. The majority of the patients were suffering from dysthymic disorder. It was found that 25% of the men and 35% of the women had recovered, 29% of the men and 24% of the women were still suffering from depression after the five-year period, 9% of the men and 11% of the women had become demented, 33% of the men and 26% of the women had died, and 4% of the cases were not contacted. The prognosis did not differ between the sexes, neither was it associated with age. Poor psychic health and pronounced depressive symptoms at the beginning of the treatment, and the occurrence of a serious disease or a decline in functional capacities during the follow-up were related to a poor prognosis in both sexes. The specific disease group related to a poor prognosis in women was that of cardiovascular diseases. A close connection between a poor prognosis and a low socioeconomic status was found in the depressed men, while a favorable prognosis was shown for relatively healthy, even widowed, depressed women who moved to live alone during the follow-up period, women who increased their amount of physical exercise, and men and women whose hobby activities increased.