Journal of affective disorders · 2026
Depression and risk of future suicidal behaviour in patients with deliberate self-harm.
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Olsson Petter, Steingrimsson Steinn, Doering Sabrina, Wiktorsson Stefan, Strömsten Lotta M J, Renberg Ellinor Salander, Runeson Bo, Waern Margda
Аннотация
BACKGROUND: Depression is strongly associated with suicidal behaviour, but whether major depressive episode (MDE) diagnosis and depressive symptom severity provide equivalent prognostic information after self-harm remains unclear.
METHODS: 739 adults were interviewed at three Swedish hospitals after an episode of deliberate self-harm; 503 women and 236 men, age range 18-95, mean age 38.4, 610 suicide attempts (SA) and 129 non-suicidal self-injuries (NSSI). The Montgomery-Åsberg Depression Rating Scale (MADRS-S), the Suicide Assessment Scale (SUAS) and the Suicide Intent Scale (SIS) were administered. Diagnoses were set using the Mini International Neuropsychiatric Interview (MINI). Fatal and non-fatal suicidal behaviour within 5 years were identified by national registers. Regression models were adjusted for age, sex, emotionally unstable personality disorder, bipolar disorder, baseline suicidal ideation and previous suicidal behaviour.
RESULTS: MDE was diagnosed in 72% (n = 534). Fatal or non-fatal suicidal behaviour occurred in 265 participants 36%). MDE was not independently associated with subsequent suicidal behaviour, whereas MADRS-S score was weakly associated after full adjustment (OR = 1.02, 95% CI 1.00-1.05, p = .037). Discriminatory performance was limited (AUC = 0.62).
CONCLUSIONS: In this diagnostically heterogeneous post-self-harm cohort, dimensional depressive symptom burden captured prognostic variation not evident from categorical MDE status. However, the association was modest, and MADRS-S had limited individual-level predictive utility. Depressive symptom severity should therefore be interpreted as one component of a broader multidimensional clinical assessment, rather than as a stand-alone risk prediction measure.
METHODS: 739 adults were interviewed at three Swedish hospitals after an episode of deliberate self-harm; 503 women and 236 men, age range 18-95, mean age 38.4, 610 suicide attempts (SA) and 129 non-suicidal self-injuries (NSSI). The Montgomery-Åsberg Depression Rating Scale (MADRS-S), the Suicide Assessment Scale (SUAS) and the Suicide Intent Scale (SIS) were administered. Diagnoses were set using the Mini International Neuropsychiatric Interview (MINI). Fatal and non-fatal suicidal behaviour within 5 years were identified by national registers. Regression models were adjusted for age, sex, emotionally unstable personality disorder, bipolar disorder, baseline suicidal ideation and previous suicidal behaviour.
RESULTS: MDE was diagnosed in 72% (n = 534). Fatal or non-fatal suicidal behaviour occurred in 265 participants 36%). MDE was not independently associated with subsequent suicidal behaviour, whereas MADRS-S score was weakly associated after full adjustment (OR = 1.02, 95% CI 1.00-1.05, p = .037). Discriminatory performance was limited (AUC = 0.62).
CONCLUSIONS: In this diagnostically heterogeneous post-self-harm cohort, dimensional depressive symptom burden captured prognostic variation not evident from categorical MDE status. However, the association was modest, and MADRS-S had limited individual-level predictive utility. Depressive symptom severity should therefore be interpreted as one component of a broader multidimensional clinical assessment, rather than as a stand-alone risk prediction measure.