The very long-term course of severe depression, with focus on suicidality

Abstract: Abstract Objective: To study the very long-term course of severe depression and the subjects own experiences many years after a suicide attempt. Method: Patients diagnosed with severe depression/melancholia between 1956 and 1969 were interviewed 37- 53 years after index admission. Seventy-five telephone interviews were held and medical records were read in many cases. Long-term course of depression was evaluated by cluster analysis. Suicide attempts were related to the depressive course. Among those interviewed, 13 who made one or more suicide attempts were in 2013 asked to attend a qualitative interview. Semi-structured interviews were held, using an interview guide and analysed according to grounded theory technique. Result: There was a short-term course, with or without recurrence, or a chronic course with or without late remission. Heredity for depression was significantly related to a chronic course, with or without late improvement. Twenty-nine subjects had attempted suicide, of whom 13 had made repeated attempts. The risk of attempting suicide decreased by 10% for every decade which depression occurred. Suicide attempts were made early in the course of depression, and there was a longer total time of depression after suicide attempts than before. Three categories where identified after a suicide attempt: coming under professional care, experiencing a relief in the personal situation and making a decision to continue to live. From these a core-category emerged labelled regaining control and taking care of oneself. Conclusion: Both long-term improvement and late recurrences are possible after a chronic course of severe depression. Our results also indicate that recovery from depression is not a precondition for ending suicidal behavior. Adding some kind of psychosocial treatment to initial somatic treatment seems important.