Clinical differences among depressed patients with and without a history of suicide attempts: Findings from the STAR^*D trial

Background: This study sought to determine whether a history of suicide attempts among outpatients diagnosed with nonpsychotic major depressive disorder (MDD) is correlated with any difference in clinical presentation that should influence patient care. Methods: Baseline data from the Sequenced Treatment Alternatives to Relieve Depression (STAR^*D) trial on outpatients with MDD treated in primary and specialty care settings were used to model significant demographic and clinical correlates of suicide attempter status. Results: Altogether, 16.5% of participants (n = 667) reported prior suicide attempts. Controlling for age, gender, and depressive symptom severity, previous attempters had more current general medical conditions (μ = 3.2 vs. 2.9, p < .0001), more current alcohol/substance abuse (p < .0001), and more work hours missed in the past week (26.2% vs. 18.2%, p < .0001) than non-attempters. On average, for the previously suicidal, the onset of MDD occurred 8.9 years earlier in life (p < .0001) and had included 1.2 additional depressive episodes (p = 0.001) compared to those without prior suicidal behavior. Previous attempters also reported more current suicidal ideation (61.3% of previous attempters, adjusted OR 1.6, vs. 45.5% of nonattempters, p < .0001). Limitations: Presence or absence of a history of suicide attempts was determined only through self report. Conclusions: Those with a history of suicidal behavior suffer a greater burden of depressive illness. Earlier intervention and ongoing, aggressive care, including maintenance-phase pharmacotherapy, may be critical to mitigating the long-term consequences associated with this increased disease burden.