Depression and Suicide: Identifying the Risk

Abstract

Depression is a mood disorder, and dysphoria and anhedonia are its core symptoms. It is a leading contributor to global disease burden because of its long-term disability. About two-thirds of all depressed patients contemplate suicide, 10-15% commit suicide and major depression accounts for up to 60% of all completed suicides. Depressive disorders can take many forms, depending on their severity and chronicity of which the most “classic” one is Major Depressive Disorder. Understanding the key risk factors linking depression and suicide is crucial for selecting optimized treatment for patients at-risk for suicide. This paper presents a review of information on predictors of suicide risk among depressed patients and about ways of identifying the risks. Depressed patients are more likely to see physicians than psychiatrists as many of them have neurovegetative symptoms perceived as a physical illness and many have coexisting medical disorders. Physicians can therefore identify at-risk individuals and possibly intervene.

Having pervasive thoughts of hopelessness, previous suicide attempts, previous psychiatric hospitalization, severe depressive symptoms, higher levels of suicidal ideation, recurrent episodes of depression, presence of personality disorders, older age, being male, unemployed status and a family history of suicide are significant markers for suicide. Additional risk factors include the presence of other psychiatric comorbidities, substance misuse, chronic physical illnesses, a recent stressful life event, social isolation and in youth, academic and financial stress. Access to lethal means is another risk factor. Suicide risk assessment in depression relies on effective communication with the patient. Clinical assessment of risk involves: (a) checking for risk factors of suicide; (b) eliciting suicidal ideation; and (c) deciding the imminent risk of suicide. There are no fixed methods to elicit suicidal ideation. Sometimes patients may inform the doctor without the need for prompting. Clinicians need to raise the topic by first using open-ended questions and gradually focusing on direct ones. Evaluation should be customized to the patient’s culture and religion. Thorough documentation is important to ensure adequate monitoring and the safety of the person. The use of objective scales significantly improves the reliability of suicide risk assessment. Discussing directly about suicide in depressed patients do not trigger suicide rather help to identify high-risk patients and to uncover risk factors. In Bangladesh, the rates of suicidal behavior are high but underexplored. Patients often deny thoughts of suicide due to their cultural stigma, religious faith or legal barrier. Lack of awareness and limited access to mental health care further hinder early detection and intervention of suicidal cases.

The findings contribute to a better understanding of suicide risk in depressive population and underscores the importance of targeted suicide prevention strategies in clinical and community settings.

Bangladesh J Medicine 2026; Vol. 37, No. 2(1): pp. 201-202