Suicide-specific mortality among patients with treatment-resistant major depressive disorder, major depressive disorder with prior suicidal ideation or suicide attempts, or major depressive disorder alone

Abstract

Background: The impact of treatment-resistant depression (TRD) or prior suicidal ideation/suicide attempt (SI/SA) on mortality by suicide among patients with major depressive disorder (MDD) is not well known. This retrospective, observational, descriptive cohort study characterized real-world rates of suicide-specific mortality among patients with MDD with or without TRD or SI/SA.

Methods: Adult patients with MDD among commercially insured and Medicare enrollees in Optum Research Database were included and assigned to three cohorts: those with treatment-resistant MDD (TRD), those with MDD and SI/SA (MDD+SI/SA), and those with MDD without TRD or SI/SA (MDD alone). Suicide-specific mortality was obtained from the National Death Index. The effects of demographic characteristics and SI/SA in the year prior to the end of observation on suicide-specific mortality were assessed.

Results: For the 139,753 TRD, 85,602 MDD+SI/SA, and 572,098 MDD alone cohort patients, mean age ranged from 55 to 59 years and the majority were female. At baseline, anxiety disorders were present in 53.92%, 44.11%, and 21.72% of patients with TRD, MDD+SI/SA, and MDD alone, respectively. Suicide-mortality rates in the three cohorts were 0.14/100 person-years for TRD, 0.27/100 person-years for MDD+SI/SA, and 0.04/100 person-years for MDD alone. SI/SA during the year prior to the end of observation, younger age, and male sex were associated with increased suicide risk.

Conclusions: Patients with TRD and MDD+SI/SA have a heightened risk of mortality by suicide compared with patients with MDD alone. Suicide rates were higher in patients with recent history versus older or no history of SI/SA, men versus women, and those of young age versus older age.

Keywords: attempted suicide; major depressive disorder; mortality; suicidal ideation; suicide; treatment-resistant depression.

FIGURE 1

Study design. This study was designed to compare rates of suicide‐specific mortality in adults with evidence of ≥2 medical claims (diagnosis of MDD) on separate dates during the observation period (January 1, 2016 and extending through the end of observation [earliest of a patient's health plan disenrollment, death, or June 30, 2019]). The sampling frame included patients who received a diagnosis of TRD, MDD+SI/SA, or MDD alone who had at least a 6‐month history prior to the index diagnosis date (earliest date of service associated with a qualifying claim for TRD, MDD+SI/SA, or MDD alone). Presence of recent SI/SA was captured in the year prior to end of observation. MDD, major depressive disorder; SA, suicidal attempt; SI, suicidal ideation; TRD, treatment‐resistant depression.

FIGURE 2

Patient identification, attrition, and cohorts. ^aDiagnosis codes for MDD could appear in either the primary or secondary position. ^bFully insured on a commercial health plan or enrolled in a nonretiree Medicare Advantage with Part D coverage health plan. ADM, antidepressant medication; APM, antipsychotic medication; MDD, major depressive disorder; NDI, National Death Index; SA, suicide attempt; SI, suicidal ideation; TRD, treatment‐resistant depression.