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Subjects
Patients used for this study were 104 men ages 18 years and over who committed suicide, as determined by the Quebec Coroner’s Office, and who met DSM-IV diagnostic criteria for major depressive disorder or depression not otherwise specified in the 6 months before their death. Individuals with depression not otherwise specified (operationally defined as depressed mood or lack of interest most of the time for at least 2 weeks and four symptoms of depression) were selected for this study because these patients most likely had major depressive disorder. They were not recognized as having such because of the reduced sensitivity of the psychological autopsy procedure, particularly for conditions present immediately before death (34). The subjects who met criteria for bipolar or any psychotic disorder were excluded to increase comparability between groups. Our subjects were consecutive male suicide victims (representative of male suicide cases in the general population) who were recruited primarily from 2000 to 2004. The acceptance rate of participation by the families of the suicide victims was 75%. Suicide cases from families who did not agree to participate were not different from those included in the study with regard to age, race, or method of suicide.
The comparison subjects were 74 living men, age-matched (within 2 years) to the cases, who met criteria for major depressive disorder with a condition severe enough to require follow-up in a specialized psychiatric outpatient clinic. The acceptance rate of participation was 90%, and those who did not agree to participate had similar demographic characteristics to those who accepted. To ensure comparability of the two groups, all comparison subjects were diagnosed by proxy-based interviews carried out on average 5 months after recruitment. This project was approved by our local institutional review board and the families of the suicide victims; comparison subjects and informants signed written informed consents.