Published: 16-08-2023 20:26 | Updated: 16-08-2023 20:30

Attempted suicide during depression linked to higher all-cause mortality

Photo of man holding his head in his hands.
Depression is the leading cause of disability worldwide. Photo: iStock

New research from Karolinska Institutet published in JAMA Psychiatry shows how suicide attempts among people with depression is associated with higher mortality and impaired functionality.

According to the WHO, some five per cent of the global adult population suffered from depression in 2021, and depression is associated with higher mortality. Suicidal ideation and attempted suicide are two of several diagnostic criteria for depression, which commonly recurs in month- or year-long episodes during a sufferer’s life.

Portrait of Johan Lundberg
Johan Lundberg. Photo: Martin Stenmark

“But our knowledge of how the group of patients who actually attempt suicide differs from the others is insufficient, both at a patient level and in societal terms,” says the study’s first author Johan Lundberg, professor of psychiatry at the Department of clinical neuroscience at Karolinska Institutet.

The results of the population-based observational study show that the patients with depression who had also attempted suicide during the depressive period under study had over twice the mortality rate, regardless of cause, of those with no registered suicide attempt.

“These findings tell us that the care provided for this particular group needs to be developed,” says Professor Lundberg.

Those who attempted suicide were younger

The study also shows that patients with depression who had also attempted suicide were younger and more commonly suffering other psychiatric comorbidities, such as anxiety and addiction. Important risk factors for suicidal acts within a year after the onset of a depressive episode were previous suicide attempts, substance use disorder, anxiety and sleeping disorders.

This patient group could benefit from particular care:

“The care services should systematically evaluate the effect of treatments like lithium, which can be expected to reduce the risk of death in this patient group,” says the study’s last author Clara Hellner, professor of child and adolescent psychiatry and director of RDE for Healthcare Provision, Stockholm County.

The study was financed by Region Stockholm and Janssen-Cilag AB. Four of the study’s authors are employed by Janssen-Cilag AB.


Determinants and Outcomes of Suicidal Behavior among Patients with Major Depressive Disorder: a Population-wide Cohort Study“, Johan Lundberg, Thomas Cars, Erik Lampa, Katarina Ekholm Selling, Amy Leval, Anna Gannedahl, Mikael Själin, Carl Björkholm, Clara Hellner, JAMA Psychiatry, online August 16, 2023, doi: 10.1001/jamapsychiatry.2023.2833