Protective factors against suicidal acts in major depression: Reasons for living

Objective: Over 30,000 people a year commit suicide in the United States. P rior attempted suicide and hopelessness are the most powerful clinical pred ictors of future completed suicide. The authors hypothesized that "reasons for living" might protect or restrain patients with major depression from m aking a suicide attempt. Method: Inpatients with DSM-III-R major depression were assessed for depres sion, general psychopathology, suicide history, reasons for living, and hop elessness. Of the 84 patients, 45 had attempted suicide and 39 had not. Results: The depressed patients who had not attempted suicide expressed mor e feelings of responsibility toward family, more fear of social disapproval , more moral objections to suicide, greater survival and coping skills, and a greater fear of suicide than the depressed patients who had attempted su icide. Scores for hopelessness, subjective depression, and suicidal ideatio n were significantly higher for the suicide attempters. Reasons for living correlated inversely with the combined score on these measures, considered an indicator of "clinical suicidality." Neither objective severity of depre ssion nor quantity of recent life events differed between the two groups. Conclusions: During a depressive episode, the subjective perception of stre ssful life events may be more germane to suicidal expression than the objec tive quantity of such events. A more optimistic perceptual set, despite equ ivalent objective severity of depression, may modify hopelessness and may p rotect against suicidal behavior during periods of risk, such as major depr ession. Assessment of reasons for living should be included in the evaluati on of suicidal patients.