We examined suicidal and nonsuicidal patients with major depression during and subsequent to their hospitalization. Factors associated with suicidality at the index episode included psychosocial variables as well as measures of family functioning. Previous suicidality, inter-episodic adjustment, changes in family constellation, and perception of family functioning were instrumental in separating nonsuicidal patients at follow-up from patients exhibiting recurrent suicidal behavior. These results indicate that when assessing patients with major depression for suicidality, particular attention should be paid both to the social environment and to family functioning as perceived by the patient.