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For 25 years the medical profession has accepted that of every 100 individuals with major depressive disorder (MDD), 15 subjects will ultimately commit suicide. The present paper demonstrates that the lifetime suicide risk in this condition cannot be so high. Conservative age-specific calculations give a lifetime suicide risk in MDD of 3.5%. Selection of hospital-based, high suicide risk, study populations in the index research, when most sufferers are out-patients, is the primary contributor to the overestimation of suicide risk. Evolving classification systems are a further factor. In terms of suicide risk, MDD is not a homogenous diagnostic category. As has been reliably replicated, the small subgroup of patients who have experienced hospital admission do experience a much greater lifetime suicide risk.

Among sufferers of major depression, men and those who have been hospitalized have a much greater risk of suicide. These findings are sensitive to diagnostic inclusivity (the algorithm's denominator) which raises the question as to whether women with a depressive illness are more likely to be correctly identified than male sufferers? An argument is made for a gender-based nosological revision of the diagnostic criteria. In the interim, given the treatable morbidity of depression and the availability of safe, well-tolerated antidepressants, there is a prima facie case for lowering our threshold of treatment in men and youths presenting with a history of anger dyscontrol, or substance abuse, who have decompensated from previous levels of functioning and who show features of either typical or atypical depression.

The hypotheses of this study were supported by the results. Twelve beds were subsequently closed as a result of the efficiencies generated by integration. These findings support the model of true integration trailled here.

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