Psychotic (delusional) depression and suicidal attempts: A systematic review and meta-analysis

R. Gournellis*, K. Tournikioti, G. Touloumi, C. Thomadakis, P. G. Michalopoulou, C. Christodoulou, A. Papadopoulou, A. Douzenis

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    48 Citations (Scopus)


    Objective: It still remains unclear whether psychotic features increase the risk of suicidal attempts in major depressive disorder. Thus, we attempted, through a systematic review coupled with a meta-analysis, to elucidate further whether unipolar psychotic depression (PMD) compared to non-PMD presents higher levels of suicidal attempts. Method: A systematic search was conducted in PubMed, EMBASE, PsycINFO as well as in various databases of the so-called gray literature for all studies providing data on suicidal attempts in PMD compared to non-PMD, and the results were then subjected to meta-analysis. Results: Twenty studies met our inclusion criteria, including in total 1,275 PMD patients and 5,761 non-PMD patients. An elevated risk for suicide attempt for PMD compared to non-PMD patients was found: The total (lifetime) fixed-effects pooled OR was 2.11 (95% CI: 1.81-2.47), and the fixed-effects pooled OR of the five studies of the acute phase of the disorder was 1.93 (95% CI: 1.33-2.80). This elevated risk of suicidal attempt for PMD patients remained stable across all age groups of adult patients. Conclusion: Despite data inconsistency and clinical heterogeneity, this systematic review and meta-analysis showed that patients with PMD are at a two-fold higher risk, both during lifetime and in acute phase, of committing a suicidal attempt than patients with non-PMD.

    Original languageEnglish
    JournalActa Psychiatrica Scandinavica
    Early online date26 Nov 2017
    Publication statusE-pub ahead of print - 26 Nov 2017


    • Age
    • Clinical features
    • Meta-analysis
    • Psychotic depression
    • Suicidal attempt
    • Systematic review


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