During suicide risk assessment in a psychiatric clinic, which of the following psychiatric diagnoses is most commonly associated with completed suicide?

Explanation

## Psychiatric Diagnosis and Suicide Risk **Key Point:** Major depressive disorder (MDD) is the most common psychiatric diagnosis associated with completed suicide, accounting for approximately 30–40% of all suicides. Depression is present in 80–90% of suicide victims at the time of death. ### Suicide Risk by Psychiatric Diagnosis | Diagnosis | Suicide Risk | Relative Risk | Notes | |-----------|--------------|---------------|-------| | Major depressive disorder | 30–40% | 20–30× baseline | Highest absolute risk; especially with psychotic features, hopelessness | | Bipolar disorder | 10–15% | 15–25× baseline | Higher during depressive and mixed episodes | | Schizophrenia | 5–10% | 10–15× baseline | Command hallucinations, paranoia increase risk | | Substance use disorder | 5–10% | 10–15× baseline | Often comorbid with depression | | Generalized anxiety disorder | 2–3% | 2–5× baseline | Lower risk unless comorbid with depression | | Adjustment disorder | <1% | 1–2× baseline | Lowest risk among major psychiatric diagnoses | | Specific phobia | <0.5% | 1× baseline | Minimal suicide risk in isolation | **High-Yield:** The lifetime suicide risk in MDD is approximately 15%, making it the single most lethal psychiatric condition. Hopelessness and anhedonia are stronger predictors than sadness alone. ### Mnemonic for High-Risk Depression Features **SADSAD** — Severe depression, Agitation, Delusions/Psychosis, Suicidal ideation with plan, Alcohol/substance use, Demographic risk (male, older, divorced) ### Clinical Pearl Depression with the following features carries the highest suicide risk: 1. Psychotic features (especially mood-congruent delusions of guilt, poverty, disease) 2. Severe anhedonia and hopelessness (not just sadness) 3. Agitation and anxiety (mixed features) 4. Recent discharge from psychiatric hospitalization 5. Comorbid substance use or medical illness **Warning:** Do not underestimate suicide risk in "mild" depression. Patients with moderate-to-severe depression and hopelessness require urgent intervention, especially if they have a specific plan and access to means.