depressed man sitting in window

The connection between depression and suicide is well-established by peer-reviewed, evidence-based research. In recent years, several factors have increased awareness about mental health issues such as depression and suicide in the United States.

First, an increase in suicide among young people aged 10-34 in the 2010s captured the attention of the media, mental health experts, and parents of teenagers and young adults. Second, the advent of social media use brought attention to increased rates of depression and anxiety among teens, particularly teenage girls. Third, the coronavirus pandemic of 2020-2021 – which we still feel the effects of – increased risk of mental health problems such as depression and anxiety among all age and demographic groups.

It’s known among mental health treatment providers and the general public that a mental health disorder can cause significant disruption in all areas of life, including:

  • Interpersonal relationships, including family, friends, and partners/spouses
  • Work performance, including the ability to seek, find, and maintain gainful employment
  • Academic performance and achievement
  • Social functioning
  • Cognitive functioning
  • Wellbeing, quality of life, and happiness

A severe mental health disorder can also prevent a person from engaging in the most basic functions of daily life, as well, which include personal hygiene, adequate activity, adequate sleep, and adequate food or nutrition.

However, the most significant risk associated with mental health disorders is premature mortality resulting from suicide. Studies show the following mental health disorders are most often associated with suicide risk.

Suicide and Mental Health Disorders

In this article, we’ll report the results of a recent publication  called “Determinants and Outcomes of Suicidal Behavior Among Patients With Major Depressive Disorder” that examined risk and rates of premature mortality among patients with major depressive disorder (MDD).

Before we look at the results of this study, we’ll review the most recent verified information on rates of clinical depression and suicidal behavior in the U.S.

Depression and Suicide in the U.S.: Facts and Figures

We have a complicated relationship with mental health care in our country. On the one hand, we have access to one of the most advanced networks of medical support and care in human history. In the 21st century, we can keep people alive and healthy through illness and injury that just last century would have resulted in permanent disability and/or death. We can send cancer into remission, perform heart and other organ transplants, and use imaging technology to see, in real time, the structure and function of the human brain.

Yet, despite these advances, many people still misunderstand mental health conditions such as depression, anxiety, obsessive-compulsive disorder (OCD), and others. This misunderstanding leads to stigma, which in turn leads to people in need of professional support declining to seek support because they fear judgment and the consequences of labels associated with mental health diagnoses.

This situation – people with mental health disorders deferring treatment due to stigma – increases risk of the most severe consequence of mental illness, suicide. That’s what makes articles like this one important: people need to understand the risks of untreated mental health disorders. And in this specific instance, our goal is to raise awareness of the association between a diagnosis of major depressive disorder, suicidal behavior/suicidal ideation, and death.

To establish the parameters of this discussion, we’ll present the latest data on rates of clinical depression and suicide in the U.S., as reported by the 2021 National Survey on Drug Use and Health (2021 NSDUH). We’ll begin with the data on depression. In the statistics below, the term major depressive episode (MDE) is a proxy metric for diagnosis of major depressive disorder.

Major Depressive Episode (MDE):

  • Adults 18+: 8.3% (21.0 million)
    • Males: 7.6 million (6.2%)
    • Females: 13.3 million (10.3%)
  • 18-25: 18.6% (6.2 million)
  • 26-49: 9.3% (9.5 million)
  • 50+: 4.5% (5.3 million)
  • 65+: 2.8% (1.5 million)

MDE With Severe Impairment

  • Adults 18+: 5.7% (14.5 million)
    • Males: 5.1 million (4.1%)
    • Females: 9.3 million (7.2%)
  • 18-25: 13.3% (4.4 million)
  • 26-49: 6.5% (6.6 million)
  • 50+: 2.9% (3.4 million)
  • 65+: 1.3% (739,000)

That’s the data on depression, which shows us that millions of people in the U.S. have depression, and millions have depression with severe impairment, which increases suicide risk.

Next, we’ll offer the latest data on rates of suicide, suicidal ideation, suicide plans, and attempted suicide in the U.S., as reported by the 2021 National Survey on Drug Use and Health (2021 NSDUH) and the National Vital Statistic System (NVSS).

Between 1999 and 2018:

  • The suicide fatality rate in the U.S. increased by 35%

Between 2008 and 2011:

  • An average of 3% of suicide attempts ended in fatality

In 2020:

  • 45,855 died by suicide. Suicide was the:
    • 12th leading cause of death among all age groups
    • 2nd leading cause of death among people age 10-34
    • 5th leading cause of death among people 35-54

In 2021:

  • Adults age 18+:
    • 12.3 million (4.3%) had serious thoughts of suicide
    • 3.5 million (1.4%) made suicide plans
    • 0.7 million (0.7%) attempted suicide
    • 1.3 million had serious thoughts of suicide, made a plan, and attempted suicide
  • Adults age 18-25:
    • 4.4 million (13%) had serious thought of suicide
    • 4.9 million (0.45%) made a suicide plan
    • 2.7 million (0.4%) attempted suicide
  • Adults age 26-49:
    • 5.4 million (0.24%) had serious thought of suicide
    • 1.5 million (0.13%) made a suicide plan
    • 700,000 thousand (0.09%) attempted suicide
  • Adults age 50+:
    • 2.0 million (0.2%) had serious thought of suicide
    • 300,000 thousand (0.07%) made a suicide plan
    • 100,000 thousand (0.06%) attempted suicide

That’s our current situation with regards to depression and suicide. In short – and according to sources up to the Surgeon General of the United States – we’re in a mental health crisis, exacerbated by recent acute stressors like the coronavirus pandemic and long-term stressors the opioid overdose crisis. To read two recent advisories on mental health published by the Surgeon General, please refer to “Protecting Youth Mental Health” and “Our Epidemic of Loneliness and Isolation.”

The Surgeon General’s Advisory on loneliness and isolation indicates the following:

“Social isolation is arguably the strongest and most reliable predictor of suicidal ideation, attempts, and lethal suicidal behavior among samples varying in age, nationality, and clinical severity.”

With that in mind, let’s take a look at the results of the study we mention in the introduction of this article.

The Connection Between Major Depressive Disorder (Depression) and Suicide

The study team examined records collected between January 2012 and December 2017 from a study group called the “Stockholm MDD Cohort” in Sweden. Researchers analyzed data in 2022, and published their results in August 2023.

The primary research question:

“What are the clinical and societal outcomes, including all-cause mortality, associated with suicidal behavior in patients with major depressive disorder (MDD)?”

To answer this question, the study team compared records from patients with major depressive disorder (MDD) with and without reports of suicidal behavior. The main outcomes researchers analyzed included mortality (death), comorbid mental health/substance use disorder, use of health care resources, and loss of work/income/employment.

Let’s take a look at the data.

MDD, Suicidal Behavior, and Mortality: Results

Among 145,577 patients, researchers identified:

  • 158,169 episodes of MDD

Among those, researchers identified:

  • 2240 (1.4%) episodes of suicidal behavior

Age of patients with MDD with records suicidal behavior (mean age):

  • 40.9 years

Gender of patients who reported MDD with records of suicidal behavior:

  • Women: 1415 episodes (63.2%)
  • Men: 825 (36.8%)

In the total sample set of 145,577, researchers identified:

  • 11,109 of MDD without episodes of suicidal behavior
    • These patient record served as the control group

Age of patients with MDD without records of suicidal behavior (mean age):

  • 40.8

Gender of patients with MDD without records of suicidal behavior:

  • Women: 7,046 (63.4%)
  • Men: 4,063 (36.6%)

Total deaths during study period:

  • 466

All-cause mortality (death) rate:

  • Patients with MDD with records suicidal behavior: 2.5 per 100 person-years
  • Patients with MDD without records suicidal behavior: 1.0 per 100 person-years

Based on this data, the research team concluded that, compared to people with MDD without suicidal behavior, suicidal behavior among people with MDD was associated with:

  • Higher all-cause mortality:
    • 162% increased risk of mortality, or a hazard ration (HR) of 2.62
  • Any use of health care resources
  • Any loss of work/employment/income

In addition, the team concluded that patients with MDD and suicidal behavior were younger and more prone to have psychiatric comorbid conditions, including:

  • Personality disorders
  • Substance use disorders
  • Anxiety/anxiety disorder at the start of depressive episode

Finally, the research team concluded that the most important factors associated with suicidal behavior within 1 year after the start of an MDD episode were:

  • Previous history of suicidal behavior
  • Age
  • History of substance use
  • History of sleep disorders
  • Diagnosis in a specialized care setting

We’ll discuss these outcomes below.

Depression, Suicide, and Mortality

While the stated goal of studies like the one we discuss above is to present reliable facts and figures about the relationship between depression, suicidal behavior, and mortality (death), the real, long-term, big-picture goal of all studies like these is something we can all understand:

To save lives.

That’s why researchers collect the data and report it in formal papers. Mental health care providers like us can use this data to recognize patients with MDD at increased risk of suicide. In this case, we learned that among people with MDD with suicidal behavior, there are a host of factors which, when present alongside a diagnosis of MDD with suicidal behavior, can increase risk of mortality (death).

To summarize the data above, the salient factors include younger age, previous history of suicidal behavior, previous history of substance use disorder, presence of mental health and/or sleep disorders, and diagnosis of MDD in a mental health care setting, as opposed to a general health/primary care setting. We can use this information to screen our patients with MDD, and if those factors are present, we can triage treatment and create an individualized treatment plan designed to reduce risk of suicide.

This study revealed two more facts:

  1. The rate of MDD episodes with suicidal behavior – 1.4% – was lower than previous research suggested.
  2. People with MDD with suicidal behavior were at over twice the risk – a 162 percent increased risk – compared to people with MDD without suicidal behavior.

The first point is interesting and encouraging: suicidal behavior among people with MDD may be less common than previous studies indicate. The second is most instructive: any suicidal behavior in a person with MDD means their risk of mortality (death) doubles. That finding will help us created treatment plans that mitigate risk of suicide, and help our patients with MDD and suicidal behavior develop the tools that allow them to manage the symptoms of depression, and, most importantly, reduce risk of suicide.

Resources: Support for Suicidal Thoughts and Behavior

Anyone who needs help managing suicidal thoughts can call or text the following numbers and receive immediate emergency support:

  • The National Suicide Prevention Lifeline (24/7/365): 988
  • The Trevor Project (designed for LGBTQIA+ Youth and Teens)
    • Phone (24/7/365): 1-866-488-7386
    • Trevor Project Text (7 days/wk, 6am-am ET, 3am-10pm PT): Text START to 678678
    • The Trevor Project Chat: CLICK HERE