DISPROPORTIONATE SUICIDALITY IN PATIENTS WITH COMORBID MAJOR DEPRESSION AND ALCOHOLISM

Objective: The two purposes of this study were to provide a comprehens ive description of the clinical features of patients who presented to an intake psychiatric setting with major depression and alcohol depend ence and to determine which clinical features distinguished this dual- diagnosis group from patients with the two relevant single diagnoses. Method: During a recent 5-year period, a total of 107 patients who cam e to a psychiatric facility for initial education were diagnosed as ha ving both major depression and alcohol dependence. The clinical profil e of this dual-diagnosis group was compared to that of nondepressed al coholics (N=497) and nonalcoholic patients with major depression (N=5, 625), assessed at the same facility, on the basis of information from the Initial Evaluation Form, a semistructured instrument containing a standardized symptom inventory that includes ratings of severity. Resu lts: The psychiatric symptom that most strongly distinguished the depr essed alcoholics from the two comparison groups was the level of suici dality. The depressed alcoholics differed significantly from the nonal coholic depressed patients on only two depressive symptoms, suicidalit y (59% higher) and low self-esteem (22% higher); they were also signif icantly distinguished from the nonalcoholic depressed patients by fact ors such as greater impulsivity, functional impairment, and abnormal p ersonal and social history markers. Conclusions: Suicidality was dispr oportionately greater than other psychiatric symptoms in the depressed alcoholics. The clinical profile of depressed alcoholics suggests tha t they suffer an additive or synergistic Effect of two separate disord ers, resulting in a disproportionately high level of acute suicidality upon initial psychiatric evaluation.