Aspects of the Suicidal Career in Severe Depression: A Comparison Between Attempts in Suicides and Controls

Suicide attempts in the long term course of illness were investigated in 89 suicides with a primary severe depression/melancholia and in matched controls. Multiaxial ratings at index admission between 1956 and 1969 enabled the selection of patients. These patients were tracked to January 1, 1984. A blind record evaluation was performed. Suicide attempts were more common among suicides than controls. General characteristics of attempts, such as severity, the use of a violent method, and repetition did not differentiate suicides from controls. Rather, there were differences in the pattern of suicide attempts. In suicides, only, re-attempts were related to number of episodes of mood disorder. Controls more often made re-attempts after a stressful life event. Serious attempts occurred early in the course of suicide attempts in female suicides, in contrast to controls. There was a correlation between the occurrence of a suicide attempt and completed suicide among male unipolar patients and female bipolar patients.