chapter  13
Depression and Suicide: A Diathesis–Stress Model for Understanding and Treatment
WithM. DAVID RUDD
Pages 20

One reason why the relationship between depression and suicide is so frequently misunderstood is that greater than 60% of those who eventually die by suicide suered a depressive spectrum disorder at some point, but not necessarily at the time of death (Lonnqvist, 2000). As Joiner, Van Orden, and Rudd

(2008) have noted, the low base rate of suicide in the general population compounds the problem further, with the suicide prevalence rate for those suering from depression more likely in the range of 6%, almost two thirds lower than originally thought. e standard mortality ratio, however, still indicates that those with major depression are 20 times more likely to die by suicide than someone in the general population. At the heart of the problem, though, is that even a 20-fold increase in the low base rate for the general population still produces a relatively small overall percentage, making suicide a rare event statistically. Regardless of how these data are interpreted, depression clearly is a signicant risk factor for suicidality, including ideation, attempts, and death; however, it is not the only diagnosis and clinical syndrome of concern. Ultimately, though, what receives the greatest public (and sometimes clinical) attention is suicidality. e Washington Post (Priest, 2008) recently noted a vefold increase in the suicide attempt rate and a signicant increase in the suicide rate in U.S. Army personnel since the beginning of the Iraq war. Such an increase underscores the need for eective, ecient, and portable treatments. Despite the low base rate nature of suicide, the rates are nonetheless alarming, particularly when compared to other causes of death. And, in light of available and eective treatments (both psychotherapy and medicines) for psychiatric illness, death by suicide is certainly tragic.