High Scores on the Montgomery-Åsberg Depression Rating Scale and Psychotic Symptoms Predict Suicide: A Prospective Cohort Study of Psychiatric Acute Ward Patients

Abstract

Objective: To investigate the role of depression severity in suicide risk by studying the predictive value of psychotic symptoms and depression scale scores, controlled for suicidal behavior and gender. Methods: We conducted a prospective cohort study of consecutive psychiatric acute ward admissions between 2005 and 2014 from a Norwegian catchment area. Inclusion criteria were an ICD-10 diagnosis of unipolar or bipolar depression with a current depressive episode (n = 1,846); depression severity was measured by the Montgomery-Åsberg Depression Rating Scale (MADRS). Patients were assessed for suicidal ideation/planning, self-harm, and recent suicide attempts on admission. Mean follow-up time was 5.5 years (minimum/ maximum: 0/10.6 years). We used Cox regression analyses and Kaplan-Meier analyses to explore potential predictors and time to suicide. Results: During the follow-up period, 46 patients died by suicide, 30 (65%) of these within the year following admission. Psychotic depression (P= .014), admission MADRS score (P= .006), suicide attempts (P= .021), and male sex (P= .043) significantly predicted suicide. Suicidal ideation and self-harm did not predict suicide. The cumulative suicide risk in psychotic depression was 1.7% after 12 weeks and 3.0% after 52 weeks. Conclusions: Depression severity as measured with the MADRS or a diagnosis of psychotic depression independently predicted suicide. More suicides may be prevented by implementing intensive treatment and post-discharge followup for patients who present to psychiatric acute wards with severe depressive episodes and recent suicide attempts, regardless of self-reported suicidal ideation, suicide plans, and self-harm.