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Editorials

Depression should be managed like a chronic disease

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7548.985 (Published 27 April 2006) Cite this as: BMJ 2006;332:985

15% suicide rate myth again

It is very disappointing that, once again, a BMJ editorial is
perpetuating the myth that 15% of people suffering from depression will
eventually commit suicide.1

A much-cited meta-analysis in 1970 found that 15% of people suffering
from depression committed suicide.2 This study focused primarily on people
hospitalised 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 & Pankratz found a
hierarchy of lifetime suicide prevalences: 8.6% in people ever
hospitalised for suicidality; 4% for affective disorder patients
hospitalised but not specifically for suicidality; 2.2% for mixed
inpatient/outpatient populations.3

Boardman and Healy analysed data from a database of suicide cases in
North Staffordshire, and used psychiatric prevalence rates form the US
National Comorbidity Survey to calculate lifetime suicide risk in people
with depression: 2.4% for any affective disorder; 1.1% for uncomplicated
cases with no mental health service contact.4

Blair-West et al. 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'.

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

References

1. Scott J. Depression should be managed like a chronic disease. BMJ.
2006 Apr 29;332(7548):985-6.

2. Guze SB, Robins E. Suicide and primary affective disorders. Br
Journal Psychiatry. 1970;117:437–8.

3. Bostwick JM, Pankratz VS. Affective disorders and suicide risk: a
reexamination. Am J Psychiatry. 2000 Dec;157(12):1925-32.

4. Boardman AP, Healy D. (2001, November). Modelling suicide risk in
affective disorders. Eur Psychiatry. 2001 Nov;16(7):400-5.

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 Jun;35(3):322-8.

Competing interests:
None declared

Competing interests: No competing interests

28 April 2006
Melissa K Raven
Lecturer
Flinders University