OBJECTIVES: To examine the humanistic and economic burden of suicidal ideation (SI) in Europe.

METHODS: A retrospective, cross-sectional analysis was performed using data from the 2017 Europe National Health and Wellness Survey. Amongst patients with major depressive disorder (MDD) (included: self-reported physician-diagnosed depression and currently taking ≥1 medication for depression; excluded: anticonvulsant/antipsychotic monotherapy, bipolar disorder, or schizophrenia), SI was identified as having severe depressive symptoms (Patient Health Questionnaire [PHQ]-9≥15) and a positive response to PHQ-9 question: "Over the past 2 weeks, how often have you been bothered by thoughts that you would be better off dead or of hurting yourself in some way?" SI patients were compared to (1) non-SI MDD 'nSI' and (2) general population controls (without a diagnosis of depression). Outcomes including health-related quality of life (HRQoL) (SF-12v2, EQ-5D), Work Productivity and Activity Impairment (WPAI), and healthcare resource utilization (HRU) were assessed using generalized linear models adjusted for covariates. Adjusted differences (AD) or relative risks (RR) and 95% confidence intervals (CI) were computed.

RESULTS: Respondents with SI (n=905) were compared to nSI (n=2403) and to healthy (n=48,752) controls. SI versus nSI patients reported significant decrements in HRQoL, including the mental (AD=-9.20, 95% CI= -9.89–-8.51) and physical (AD=-2.00, 95% CI= -2.75–-1.25) component scores of the SF-12v2 and EQ-5D (AD=-0.18, 95% CI=-.19–-.16), and increases in healthcare provider visits (RR=1.38, 95% CI=1.27–1.50), emergency department visits (RR=1.49, 95% CI=1.29–1.73), and hospital admissions (RR=1.60, 95% CI=1.34–1.92). Work and activity impairments were higher for SI than nSI including, overall activity (RR=1.39, 95% CI=1.28–1.50). Even greater differences were observed for all outcomes when compared to the general population (all statistically significant, p<0.05).

CONCLUSIONS: Results suggest that SI represents a substantial additional burden even within the MDD population by having significant impacts on HRQoL and costs related to work and activity loss and HRU.