Commorbid conditions as predictors of suicidality in patients with depressive disorder

Cilj istraživanja je bila procjena suicidalnosti u bolesnika koji su oboljeli od depresivnog poremećaja u korelaciji sa suicidalnošću u bolesnika koji su oboljeli od depresije i nekog drugog psihičkog poremećaja i/ili tjelesne bolesti. Istraživanje je provedeno presječnom studijom među 100 bolesnika oboljelih od depresivnog poremećaja i depresivnog poremećaja u komorbiditetu s drugim psihičkim i tjelesnim bolestima koji su liječeni u Klinici za psihijatriju Vrapče, hospitalno i ambulantno od 1. siječnja do 1. svibnja 2015.godine. Dijagnoza depresije, ostalih psihičkih poremećaja i tjelesnih bolesti postavljena je sukladno dijagnostičkim kriterijima MKB-10 i DSM-IV. Za svakog pojedinog bolesnika iz uzorka, po primitku na bolničko liječenje ili po dolasku na ambulantni pregled, prikupljena su sociodemografska, hospitalna i klinička obilježja, dok se suicidalnost procjenjivala skalom za ocjenu rizika od suicida Sveučilišta Columbia (C–SSRS). Ispitanici su osim na mono i komorbidne dijagnoze depresije podijeljeni u četiri kategorije: oni koji boluju od depresije, oni koji uz depresiju imaju tjelesnu bolest,oni koji uz depresiju imaju psihički poremećaj i oni koji uz depresiju imaju tjelesnu bolest i psihički poremećaj (multipli morbiditet). Ispitali smo povezanost suicidalnih razmišljanja sa spolom i komorbiditetom, intenzitet i učestalost te razlike u pripremi, pokušaju, broju i načinu suicida. U odnosu na karakteristike suicidalnosti, posebno su proučavani bolesnici s pokušajem suicida, njih 39, kao ukupni uzorak i podijeljeni u kategorije. Istraženo je postoji li razlika u suicidalnom ponašanju, odnosno u riziku od pokušaja suicida kod osoba koje imaju samo depresiju i onih koji uz depresiju imaju tjelesnu bolest i /ili psihički poremećaj. Ovim istraživanjem postignut je važan rezultat, dokazano je da komorbiditet nije izuzetak nego pravilo čime se apostrofira važnost prepoznavanja komorbiditeta u kliničkoj praksi. U uzorku istraživanja, koji je limitiran malim brojem ispitanika, vidljivo je da samo 12% bolesnika ima depresivni poremećaj kao zasebnu dijagnozu. Istraživanjem je utvrđeno na razini apsolutnih brojeva i postotaka da je komorbiditet naša klinička stvarnost te da je suicidalnost povezana s brojem dijagnoza odnosno što je veći broj dijagnoza veći je rizik od suicidalnosti. Analiza uzorka s obzirom na pokušaj suicida pokazuje da je u uzorku bilo 39 depresivnih bolesnika koji su pokušali suicid. S obzirom na proporciju suicidalnih bolesnika u istraživanju, vidi se da se radi o prigodnom, ali premalom uzorku da bi dobiveni rezultati bili na razini statističke značajnosti. Međutim, dobiveni rezultati i trendovi u velikoj mjeri podupiru hipoteze provedenog istraživanja.The aim of the research was to assess suicidality in patients suffering from depressive disorder correlated to suicidality in patients who are suffering from depression and other mental disorders and/or somatic diseases. The study was conducted as cross-sectional study among 100 patients with depressive disorder and depressive disorder in comorbidity with other mental and/or physical illnesses treated in psychiatric hospital Vrapče, with regard to both inpatient and outpatient basis from January 1 to May 1, 2015. The diagnosis of depression, other psychiatric disorders and physical illnesses is set in accordance with the diagnostic criteria of ICD-10 and DSM-IV. The sociodemographic, hospital and clinical features of each patient in the sample were collected upon receipt for the hospitalization or upon arrival at the check-ups, while suicidality was assessed according to the scale for evaluating the risk of suicide by Columbia University (C-SSRS). Respondents were divided, in addition to mono and comorbid diagnosis of depression, into four categories: (I) those who suffer from depression, (II) those with both depression and a physical illness, (III) those with both depression and mental disorder and (IV) those with depression, physical illness and mental disorder altogether (multiple morbidity). We examined the correlation between suicidal thinking, sex and co-morbidity. We also examined the intensity and frequency of suicidal thinking as well as the differences in preparation, attempt, the number and manner of suicides. In relation to the character of suicide, particularly studied patients were those who attempted suicide, 39 of them. They were taken as the total sample and were divided into categories: those who have depression as a separate disorder, those who have both depression and physical illness, those with both depression and/or other mental disorder, and patients with depression, physical illness and mental disorder altogether. The research investigated if there is a difference between these groups in suicidal behavior. The main focus was to establish the correlation between the risk of suicide attempts among people with depression alone (mono diagnosis) and those with both depression and physical illness or other mental disorder (comorbidity or dual diagnosis). The study came to a significant discovery. It was shown that comorbidity is not an exception, but rather the rule which stresses the importance of recognizing comorbidity in clinical practice. In a sample survey, which was limited by a small number of patients, it was shown that only 12% of patients have depressive disorder as a mono diagnosis. The survey found on the level of absolute numbers and percentages that comorbidity is, in fact, our clinical reality, and that suicides are associated with the number of diagnosis- the increased number of diagnosis leads to a greater risk of suicidality. The analysis of the sample with respect to the suicide attempt shows that the sample consisted of 39 depressed patients who have attempted suicide. Given the proportion of suicidal patients in the study, it can be seen that it is an appropriate, but not a sufficiently large sample that would solidify results at the level of statistical significance. However, the results and trends largely affirm the hypotheses of the study