Suicide in Affective and Schizoaffective Disorders

Suicide is a neglected but frequent outcome of the spontaneous course of affective disorders. Lifetime suicide rates for depression were reported in 1970 by Guze and Robins to be between 12% and 19%. Fifty to sixty percent of all suicides in the normal population are due to affective disorders. Barraclough et al. (1974) found a depression in 64% of the suicides they studied, Hagnell et al. (1982) in more than 50% of subjects in the Lundby Study. Robins et al. (1959) found an affective disorder in 45% of cases. Rich et al. (1986) investigated 286 cases in the San Diego Suicide Study: in the younger age-group, less than 30 years old, 38% were depressives, in the older group 56%. Hagnell et al. (1982) found that especially men commit suicide very early after onset Of the first depressive episode and after a relatively short ambulatory treatment. The high. suicide rate for affective disorders is frequently not noticed; particularly short-term observations and treatments usually neglect the problem totally. In a small group treated over a short period, suicide is a rare event. Therefore, most reports on such treatments as psychotherapy or drugs do not mention suicide at all, and one might believe that the majority of depressives feel just fine after a treatment. In fact, as far as we know, modern psychiatric interventions have not yet been proven capable of reducing the suicide rate of depressives. On the contrary, in many Western countries the suicide rates of hospitalized psychiatric patients have increased more than the population growth and also more than the suicide rates for the total population (Ernst et al. 1980).