REVISING THE RISK OF SUICIDE IN AFFECTIVE DISORDERS

Abstract
In 1970 Guze and Robins published a meta-analysis of suicide in affectively ill patients that projected a lifetime risk of 15 percent. In the ensuing three decades, this figure has indiscriminately been applied to all depressive disorders and cited uncritically in hundreds of journal articles and textbooks. Using case fatality rather than proportionate mortality methods to estimate suicide prevalence, our 2000 paper in the American Journal of Psychiatry argues for a lower estimate of suicide risk. We report a hierarchy of risk based on the intensity of the treatment setting. In affectively ill patients ever hospitalized with suicidality, the lifetime prevalence of suicide is 8.6 percent. For patients hospitalized without suicidality specification, the lifetime risk is 4.0 percent. For mixed inpatient-outpatient populations, the risk is 2.2 percent. We observe that the fact a patient has ever been hospitalized with depression, particularly if accompanied by suicidality, robustly indicates heightened lifetime suicide risk. We also point out that one figure for suicide risk cannot be generalized to all depressive diagnoses, which include conditions with varying degrees of lethality. Future research efforts should attempt to distinguish characteristics making certain forms of depression more deadly than others.

Key words
Trastornos afectivos, depresión, riesgo suicida

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