The contribution of environmental events and social support to serious suicide attempts in primary depressive disorder.

In order to investigate the contribution of environmental events to the occurrence of serious suicide attempts, patients were interviewed about the events that occurred to them or their spouse in the 12 months previous to the actual suicide attempt. Several methodological improvements relative to previous events and suicide research were incorporated in the study. Only primary depressive attempters (n= 14) were selected, and for purposes of comparison, a primary depressive control group (n = 14) was selected. Moreover, seriousness of suicide attempt was quantified and assessed in each patient, and only moderately or severely serious attempters were chosen. The results showed that the occurrence of serious suicide attempts is strongly associated with an increased rate of independent events (events not influenced by the patient's behavior, decisions, or disorder) in the year preceding the attempt, and that a particularly high density of such events between episodic onset and the attempt may serve as the direct initiator of an attempt. Our data also suggest that exit events, where an important social support is lost to the patient, may play a particularly significant role in initiating an attempt. Moreover, the findings suggest that the presence of social support may buffer the impact of exit events and thereby reduce suicidal risk. Implications of our findings for the highest risk period of suicide are discussed.