Résumé
Objective: Although suicidal ideation (SI) is commonly regarded as a symptom of major depressive episodes (MDE), emerging evidence suggests it may carry prognostic significance for the depressive illness. This study examined whether SI during a MDE independently predicts risk of recurrence or chronicity over a three-years period.Methods: Data were drawn from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of U.S. adults. We included 2853 participants with past-year DSM-IV MDE at Wave 1 who completed Wave 2 assessments and had complete clinical and sociodemographic data. Multivariate logistic regression was used to identify predictors of chronic (i.e., persistent MDE) or recurrent MDE (i.e., new episode after remission) at Wave 2, adjusting for depression severity, comorbid psychiatric disorders, sociodemographic factors, and history of suicide attempts.Results: Suicidal ideation during a MDE was associated with a significantly increased risk of MDE recurrence or chronicity at follow-up (adjusted OR = 1.47; 95%CI: 1.16-1.85; p = 0.0010), independent of depression severity and other covariates. In contrast, a history of suicide attempt was not a significant predictor when SI was included in the model. Additional predictors included depression severity, generalized anxiety disorder, post-traumatic stress disorder, and borderline personality disorder.Conclusions: Suicidal ideation during a MDE is independently associated with the risks of chronic or recurrent depression, underscoring its clinical relevance beyond suicide risk alone. Routine assessment and targeted interventions for suicidal ideation should be prioritized in both psychiatric and primary care settings to mitigate these risks.