The Relationship between Low Self-Esteem and Suicide Attempt in Patients with Major Depressive Disorder: A Pilot Study

Jeon, Hankaram; Jon, Duk In; Hong, Hyun Ju; Hong, Narei; Park, Eun Hee; Jung, Myung Hun

Abstract

OBJECTIVE
Depression is a major risk factor for suicide, and several psychological factors such as low self-esteem are involved in suicide. The aim of this study was to investigate the difference in self-esteem between non suicide attempters and suicide attempters with major depressive disorder.
METHODS
The study subjects consisted of 52 patients who received inpatient or outpatient treatments at the Hallym University Sacred Heart Hospital. All participants were diagnosed as major depressive disorder by Korean version of the Mini-International Neuropsychiatric Interview. Columbia Suicide Severity Rating Scale (C-SSRS) was used to evaluate patient's suicide attempt. They completed a questionnaire that included Rosenberg Self-Esteem Scale, Beck Depression Inventory (BDI) and Beck Scale for Suicide Ideation (BSI).
RESULTS
A total of 52 subjects were evaluated by C-SSRS, and among them, 32 were non suicide attempters and 20 were suicide attempters. Compared to non suicide attempters, suicide attempters showed significantly lower levels of self-esteem (t=3.492, p=0.001) and higher levels of BSI (t=-4.890, p<0.001). Although there was no significant difference between two groups for severity of overall depressive symptoms, negative attitude subscale of BDI was higher in suicide attempters than non suicide attempters (t=-2.596, p=0.014). A stepwise multivariate logistic regression analysis showed that low self-esteem was significant association with suicide attempt after adjusted by negative attitude subscale of BDI and BSI (odds ratio=0.779, p=0.042).
CONCLUSION
The present study indicated that low self-esteem plays a significant role in suicide attempters with major depressive disorder. Assessment of suicide risk should include not only suicide ideation and severity of overall depressive symptoms but also low self-esteem.