Major depressive episode is the most important risk factor for lifetime suicide attempts

The ESEMeD 2000 study found that major depressive episode is the most important risk factor for lifetime suicide attempts among examined respondents from 6 EU-countries, with a population attributable risk proportion of roughly 28%, which implies that the lifetime prevalence of suicide attempts could be cut by almost one-third by preventing major depression (Bernal et al., 2007).

For more details see Factors associated with suicidal ideation and attempts in 6 EU-countries and Relative Risk for lifetime suicide attempts

High rate of suicide ideas does not always correlate with high completed suicide rates

Depression and dysthymia are also associated with an increased premature mortality due to suicide. A high rate of suicide ideas does not always correlate with high completed suicide rates. For example, a higher frequency of completed suicide was found among men compared to women (see suicide), while suicide ideation and suicide attempts are more prevalent in women (see suicide ideation). There was a correlation between the high suicide ideas and the high completed suicide rates found in Belgium and France. Also, Italy and Spain ranked last in suicidality ideas as well as in completed suicide rates. The Netherlands, however, had relatively low rate of completed suicide and intermediate rates in suicidal ideation and attempts (Alonso et al., 2008). For 15-34 years old people suicide is one of the top two leading causes of death in Europe (Murray & Lopez, 1996).

Highest suicide rates found in Eastern Europe

Suicide rates vary considerably across Europe. Generally speaking, the countries with the highest suicide rates are found in Eastern Europe (including the Baltic states), and the lowest rates are found in southern Europe. In all countries, higher rates of completed suicides are found in males than in females. The differences in suicide rates between countries cannot be explained by differences in risk factors for suicidality (Värnik et al., 2008, Bernal et al., 2007). Suicide rates depend on a complex combination of factors, such as availability of suicide means, the prevalence of mental disorders, and societal processes (Levi et al., 2003).

Lifestyle factors and chronic illness related to early mortality

Early mortality in depressed persons can also be due to other causes, besides suicide. Associations between depression and smoking, depression and substance abuse and depression and chronic physical illness are all thought to contribute to earlier deaths for depressed persons (Wulsin et al., 1999). Associations have also been found between depression and poor outcomes in breast cancer, malignant melanoma, and cardiovascular disease (Greden, 2001). Prospective epidemiological studies reveal that depression increases the risk for cardio-vascular disease later in life with the factor 2 – 2.5 (Glassman & Shapiro, 1998). In fact, depression affects about 40% of all cardio-vascular patients and worsens prognosis after myocardial infarction (Frasure-Smith et al., 1993). In addition, increased premature mortality in depression and dysthymia is related to a higher rate of accidents (Wulsin et al., 1999; Joukamaa et al., 2001).