BMJ  2006;332:1154 (13 May), doi:10.1136/bmj.332.7550.1154

Letter

Depression should be managed like a chronic disease

Myth of 15% suicide rate was promulgated again

EDITOR—Scott's editorial arguing that depression should be managed as a chronic disease perpetuates the myth that 15% of people with depression will eventually commit suicide.¹

A much cited meta-analysis in 1970 found that 15% of people with depression committed suicide.² It focused primarily on people admitted with severe depression, so it should never have been generalised to the broader population of people with depression.

Several rigorous studies have subsequently been published refuting the 15% claim. A meta-analysis by Bostwick and Pankratz found a hierarchy of lifetime suicide prevalences: 8.6% in people ever admitted for suicidality, 4% in patients admitted with affective disorder but not specifically for suicidality, and 2.2% in mixed inpatient and outpatient populations.³

View larger version (127K): [in this window] [in a new window]   Credit: PHOTOS.COM

 

Boardman and Healy analysed data from a database of suicide cases in North Staffordshire, and used psychiatric prevalences from the US national comorbidity survey to calculate lifetime suicide risk in people with depression: 2.4% for any affective disorder and 1.1% for uncomplicated cases with no mental health service contact.⁴

Blair-West and Mellsop also found a much lower risk: "The suicide risk in major depression as it is currently defined diagnostically is of the order of 3.4% rather than the previously accepted figure of 15%."⁵ They noted: "Because every major textbook quotes a suicide risk in major depression of 15%, every good psychiatry trainee and, quite reasonably therefore, any speaker who needs to emphasize the seriousness of major depression as a public health concern, uses this figure too. What is probably the most surprising is that a single paper, that by Guze and Robins, could be so uncritically accepted and so widely promulgated."

Why is it still being promulgated by the BMJ 36 years later?

Department of Public Health, Flinders University, Box 2100, Adelaide, SA 5001, Australia melissa.raven{at}flinders.edu.au

---

Competing interests: None declared.

References

1. Scott J. Depression should be managed like a chronic disease. BMJ 2006;332: 985-6. (29 April.)[Free Full Text]
2. Guze SB, Robins E. Suicide and primary affective disorders. Br J Psychiatry 1970;117: 437-8.[Free Full Text]
3. Bostwick JM, Pankratz VS. Affective disorders and suicide risk: a reexamination. Am J Psychiatry 2000;157: 1925-32.[Abstract/Free Full Text]
4. Boardman AP, Healy D. Modelling suicide risk in affective disorders. Eur Psychiatry 2001;16: 400-5.[Medline]
5. Blair-West GW, Mellsop GW. Major depression: does a gender-based down-rating of suicide risk challenge its diagnostic validity? Aust N Z J Psychiatry 2001;35: 322-8.[Medline]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Article

Depression should be managed like a chronic disease

Jan Scott
BMJ 2006 332: 985-986. [Extract] [Full Text] [PDF]