Objective To explore the clinical characteristics and treatment decisions of depressive disorder patients with suicidal ideation or behavior based on real-world evidence. Methods The clinical data of patients were extracted utilizing the electronic health record （EHR） based on the hospital information system and analyzed by descriptive research method. A total of 7 985 depression patients who were hospitalized and treated with emergency observation at Beijing Anding Hospital affiliated with Capital Medical University from January 1， 2013 to December 31， 2020 were selected as the study subjects. They were divided into three groups based on the presence of suicidal ideation or behavior： major depressive disorder with nonsuicide （MDNS）， major depressive disorder with suicidal ideation （MDSI）， and major depressive disorder with suicidal behavior （MDSB）. The differences were compared among the three groups in demographics， clinical characteristic， and treatment decisions. The risk factors for suicidal ideation or behavior in patients with depression were analyzed by multivariate logistic regression. Results Among the 7 985 patients with depression， 3 297 （41.3%） were in the MDSI group， 840 （10.5%） were in the MDSB group， and 3 848 （48.2%） were in the MDNS group. The age and onset age of patients in the MDSI and MDSB groups were lower than those in the MDNS group， and the proportion of working/studying patients was higher than that in the MDNS group， with statistical significance （all P ＜ 0.05）. The proportion of patients with psychiatric symptoms in the MDSB group was higher than that in the MDSI group， and the difference was statistically significant （P＜ 0.05）. The proportion of patients with pathogenic factors in the MDSI group was higher than that in the MDNS group， and the difference was statistically significant （P＜0.05）. Multivariate logistic regression analysis showed that working/studying （OR=1.230， 95%CI=1.022-1.480， P＜ 0.05） and having underlying causes （OR=1.186， 95%CI=1.021-1.378， P＜ 0.05） were risk factors for suicidal ideation in patients with depression. The gender of female was a risk factor for suicidal behavior in patients with depression （OR=1.487， 95%CI=1.147-1.929， P＜ 0.05）. The proportion of patients in the MDSI and MDSB groups who received complex treatment regimens such as antidepressants combined with mood stabilizers， antidepressants combined with mood stabilizers， and antipsychotic drugs was higher than that in the MDNS group， and the difference was statistically significant （P＜ 0.05）. Conclusions Gender of female， current working/studying， pre-existing triggers are independent risk factors for suicidal ideation or behavior in patients with depressive disorder， and more treatment plans should be used with antidepressants combined with mood stabilizers or combined with mood stabilizers and antipsychotics.