Childhood depression and risk of suicide: a preliminary report of a longitudinal study.

In the course of locating a sample of 427 adults who were assessed as children or adolescents with either major depressive disorder, mixed anxiety states, or no psychiatric disorder (normal controls), we found seven cases of suicide. Of the original sample, we located 159 of the 204 subjects with major depressive disorder (78%), 37 of the 66 subjects with anxiety disorders (56%), and 85 of the 177 normal controls (48%). All seven suicides occurred exclusively among the 159 children located from the major depressive disorder group, yielding a rate of 4.4% over approximately 10 years. Psychological autopsy was conducted in the seven suicide victims to assess the psychological status since the initial assessment and at the time of death. Although the onset of the first depressive episode in these victims was around puberty, the suicides usually did not occur until late adolescence or early adulthood. At least five of the seven subjects had recurrent depressive symptoms and were clinically depressed at the time of death. These preliminary findings suggest that major depressive disorder in childhood has significant mortality by suicide.