Abstract: Objective:To assess the clinical characteristics of elderly patients with first onset depression with psychotic symptoms.Methods:One hundred and nine elderly patients with first onset depression were divided into group A (with psychotic symptoms,n=15) and group B (without psychotic symptoms,n=94),and the clinical characteristics were compared between them.Results:The suicide rate in group A was 53.3%,which was significantly higher than that in group B (24.5%).The difference was significant (P<0.05).The suicidal behavior was significantly related to delusion (RR=3.53).The most common psychotic symptoms were delusions of guilty (40.0%),persecution (13.3%) and hypochondriasis (6.7%),and 40.0% of the patients were accompanied with auditory hallucinations.There were significant differences in treatment with antipsychotics and antidepressants between the two groups (P=0.018).No significant difference was observed in recent efficacy between the two groups (P>0.05).Conclusions:Suicidal behavior is more common in elderly depression patients with psychotic symptoms,and antidepressants combined with antipsychotics should be applied to those with psychotic symptoms.