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Cited by 878Suicide and Self-Harm StudiesBipolar Disorder and TreatmentHomicide, Infanticide, and Child Abuse

Affective disorders and suicide risk: a reexamination

Bostwick, John Michael, Pankratz, V. Shane·2000·American Journal of Psychiatry
DOI 10.1176/appi.ajp.157.12.1925
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Abstract

OBJECTIVE: In 1970, Guze and Robins published a meta-analysis of suicide in patients with affective illness that inferred a lifetime risk of 15%. Since then, this figure has been generalized to all depressive disorders and cited uncritically in many papers and textbooks. The authors argue for an alternative estimate of suicide risk and question the generalizability of the Guze and Robins estimate. METHOD: The authors sorted studies obtained through a literature search that included data pertaining to suicide occurrence in affective illness into one of three groups: outpatients, inpatients, or suicidal inpatients. Suicide risks were calculated meta-analytically for these three groups, as well as for two previously published collections. RESULTS: There was a hierarchy in suicide risk among patients with affective disorders. The estimate of the lifetime prevalence of suicide in those ever hospitalized for suicidality was 8.6%. For affective disorder patients hospitalized without specification of suicidality, the lifetime risk of suicide was 4.0%. The lifetime suicide prevalence for mixed inpatient/outpatient populations was 2.2%, and for the nonaffectively ill population, it was less than 0.5%. CONCLUSIONS: The percentage of subjects dead due to suicide (case fatality prevalence) is a more appropriate estimate of suicide risk than the percentage of the dead who died by suicide (proportionate mortality prevalence). More important, it is well established that patients with affective disorders suffer a higher risk of suicide relative to the general population. However, no risk factor, including classification of diagnostic subtype, has been reliably shown to predict suicide. This article demonstrates a hierarchy of risk based on the intensity of the treatment setting. Given that patients with a hospitalization history, particularly when suicidal, have a much elevated suicide prevalence over both psychiatric outpatients and nonpatients, the clinical decision to hospitalize in and of itself appears to be a useful indicator of increased suicide risk.

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Crossref · 10.1176/appi.ajp.157.12.1925

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112 of 112 references verified0 citation errors · 0 not checkable

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  • The vast majority of those who die by suicide suffer from mental disorders; however, the vast majority of those with mental disorders, including disorders with the highest suicide rates, will not attempt or die by suicide, though many will think about suicide.

    “The vast majority of those who die by suicide suffer from mental disorders (Cavanagh, Carson, Sharpe, & Lawrie, 2003); however, the vast majority of those with mental disorders, including disorders with the highest suicide rates, will not attempt or die by suicide, though many will think about suicide (Bostwick & Pankratz, 2000; Hawton, Sutton, Haw, Sinclair, & Harriss, 2005; Herzog, Greenwood,”

    From The interpersonal theory of suicide. (2010) · cites this paper as Bostwick & Pankratz, 2000

  • Meta-analyses that were based on more sophisticated statistical methods and included large long-term follow-up studies found lower figures.

    “Meta-analyses that were based on more sophisticated statistical methods and included large long-term follow-up studies found lower figures (Bostwick & Pankratz 2000, Inskip et al. 1998, Palmer et al. 2005).”

    From Excess early mortality in schizophrenia. (2014) · cites this paper as Bostwick & Pankratz 2000

  • Several investigators later concluded that Miles's estimates were most likely too high.

    “Several investigators later concluded that Miles's estimates were most likely too high for various reasons (Blair-West et al. 1997, 1999;Bostwick & Pankratz 2000;Inskip et al. 1998;Palmer et al. 2005).”

    From Excess early mortality in schizophrenia. (2014) · cites this paper as Bostwick & Pankratz 2000

  • Major depressive disorder is associated with higher risk of early death from a broad set of physical disorders and from suicide.

    “MDD is also associated with elevated risk of onset, persistence, and severity of a wide range of chronic physical disorders as well as with increased early mortality due to an even wider range of physical disorders and to suicide.”

    From The Costs of Depression (2012) · cites this paper as [119]

  • Major depressive disorder is associated with significantly elevated risk of early death, partly due to high suicide risk and partly due to elevated risk of many physical disorders; it is also associated with elevated mortality risk among people with certain disorders as part of a larger pattern of associations with disorder severity.

    “MDD is associated with significantly elevated risk of early death.104, 106, 119 This is true partly because people with MDD have high suicide risk,120–122 but also because depression is associated with elevated risk of the many types of disorders noted above. MDD is also associated with elevated mortality risk among people with certain kinds of disorders as part of a larger pattern of associations”

    From The Costs of Depression (2012) · cites this paper as [119]

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Authors
Bostwick, J. M., & Pankratz, V. S.
Affiliations
Mayo Clinic (US)
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2000-12-01
Volume
157
Issue
12
Pages
1925-1932
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.157.12.1925
OpenAlex
W2150087029
Cited by
878
References
112
Citations by year
2026: 11 · 2025: 12 · 2024: 43 · 2023: 22 · 2022: 25 · 2021: 44 · 2020: 39 · 2019: 39 · 2018: 47 · 2017: 41 · 2016: 51 · 2015: 52 · 2014: 52 · 2013: 47 · 2012: 43
FWCI
18.80
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
Keywords
suicide risk, mood disorders, depression, case fatality, hospitalization, psychiatric inpatients, psychiatric outpatients, suicide risk prediction
MeSH terms
Aged, Ambulatory Care, Cause of Death, Hospitalization, Humans, Risk Factors, Suicide, Mood Disorders

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