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Suicidal risk factors in major affective disorders

  • Ross J. Baldessarini (a1), Leonardo Tondo (a2), Marco Pinna (a3), Nicholas Nuñez (a4) and Gustavo H. Vázquez (a5)...

Abstract

Background

Rates and risk factors for suicidal behaviour require updating and comparisons among mood disorders.

Aims

To identify factors associated with suicidal risk in major mood disorders.

Method

We considered risk factors before, during and after intake assessments of 3284 adults with/without suicidal acts, overall and with bipolar disorder (BD) versus major depressive disorder (MDD), using bivariate comparisons, multivariable regression modelling and receiver operating characteristic (ROC) analysis.

Results

Suicidal prevalence was greater in BD versus MDD: ideation, 29.2 versus 17.3%; attempts, 18.8 versus 4.78%; suicide, 1.73 versus 0.48%; attempts/suicide ratio indicated similar lethality, 10.9 versus 9.96. Suicidal acts were associated with familial BD or suicide, being divorced/unmarried, fewer children, early abuse/trauma, unemployment, younger onset, longer illness, more dysthymic or cyclothymic temperament, attention-deficit hyperactivity disorder (ADHD), substance misuse, mixed features, hospital admission, percentage time unwell, less antidepressants and more antipsychotics and mood stabilisers. Logistic regression found five independent factors: hospital admission, more depression at intake, BD diagnosis, onset age ≤25 years and mixed features. These factors were more associated with suicidal acts in BD than MDD: percentage time depressed/ill, alcohol misuse, >4 pre-intake depressions, more dysthymic/cyclothymic temperament and prior abuse/trauma. ADHD and total years ill were similar in BD and MDD; other factors were more associated with MDD. By ROC analysis, area under the curve was 71.3%, with optimal sensitivity (76%) and specificity (55%) with any two factors.

Conclusions

Suicidal risks were high in mood disorders: ideation was highest with BD type II, attempts and suicides (especially violent) with BD type I. Several risk factors for suicidal acts differed between BD versus MDD patients.

Declaration of interest

No author or immediate family member has financial relationships with commercial entities that might appear to represent potential conflicts of interest with the information presented.

Copyright

Corresponding author

Correspondence: R. J. Baldessarini, Mailman Research Center 3, McLean Hospital, 115 Mill Street, Belmont, MA 02478-9106, USA. Email: rbaldessarini@mclean.harvard.edu

References

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1Harris, EC, Barraclough, B. Suicide as an outcome for mental disorders: a meta-analysis. Br J Psychiatry 1997; 170: 205–28.
2Hawton, K, Sutton, L, Haw, C, Sinclair, J, Harriss, L. Suicide and attempted suicide in bipolar disorder: systematic review of risk factors. J Clin Psychiatry 2005; 66: 693704.
3Schaffer, A, Isometsä, ET, Tondo, L, Moreno, D, Turecki, G, Reis, C, et al. International Society for Bipolar Disorders Task Force on Suicide: meta-analyses and meta-regression of correlates of suicide attempts and suicide deaths in bipolar disorder. Bipolar Disord 2015; 17: 116.
4Tondo, L, Baldessarini, RJ. Suicide in bipolar disorder. In The Bipolar Book: History, Neurobiology, and Treatment (eds Yildiz, A, Nemeroff, C, Ruiz, P): 509–28. Oxford University Press, 2015.
5Tondo, L, Pompili, M, Forte, A, Baldessarini, RJ. Suicide attempts in bipolar disorders: comprehensive review of 101 reports. Acta Psychiatr Scand 2016; 133: 174–86.
6Tondo, L, Lepri, B, Baldessarini, RJ. Risks of suicidal ideation, attempts and suicides among 2826 men and women with types I and II bipolar, and recurrent major depressive disorders. Acta Psychiatr Scand 2007; 116: 419–28.
7Tondo, L, Baldessarini, RJ, Vázquez, G, Lepri, B, Visioli, C. Clinical responses to antidepressants among 1036 acutely depressed patients with bipolar or unipolar major affective disorders. Acta Psychiatr Scand 2013; 127: 355–64.
8Tondo, L, Visioli, C, Preti, A, Baldessarini, RJ. Bipolar disorders following initial depression: Modeling predictive clinical factors. J Affect Disord 2014; 167: 44–9.
9Tondo, L, Vázquez, GH, Pinna, M, Vaccotto, PA, Baldessarini, RJ. Characteristics of depressive and bipolar patients with mixed features. Acta Psychiatr Scand 2018; 138: 243–52.
10Italian Ministry of Economics and Finances. Autorizzazione generale al trattamento dei dati personali effettuato per scopi di ricerca scientifica (Autorizzazione n. 9/2014) [General authorization to treatment of personal data for scientific research (Authorisation no. 9/2014)]. Gazzetta Ufficiale Serie Generale n. 301, 30 December 2014 (http://www.gazzettaufficiale.it/atto/serie_generale/caricaDettaglioAtto/originario;jsessionid=kOI0R58vW5a9RX4mnszi2A__.ntc-as5-guri2b?atto.dataPubblicazioneGazzetta=2014-12-30&atto.codiceRedazionale=14A09919&elenco30giorni=false).
11American Foundation for Suicide Prevention (AFSP). Suicide statistics. AFSP, 2017 (www.afsp.org/AboutSuicide/Suicide-Statistics).
12Hansson, C, Joas, E, Pålsson, E, Hawton, K, Runeson, B, Landén, M. Risk factors for suicide in bipolar disorder: a cohort study of 12,850 patients. Acta Psychiatr Scand 2018; 138: 456–63.
13Chaudhury, SR, Grunebaum, MF, Galfalvy, HC, Burke, AK, Sher, L, Parsey, RV, et al. Does first episode polarity predict risk for suicide attempt in bipolar disorder? J Affect Disord 2007; 104: 245–50.
14Bellivier, F, Yon, L, Luquiens, A, Azorin, JM, Bertsch, J, Gerard, S, et al. Suicidal attempts in bipolar disorder: results from an observational study (EMBLEM). Bipolar Disord 2011; 13: 377–86.
15Bottlender, R, Jäger, M, Strauss, A, Möller, HJ. Suicidality in bipolar compared to unipolar depressed inpatients. Eur Arch Psychiatry Clin Neurosci 2000; 250: 257–61.
16Isometsä, E. Suicidal behavior in mood disorders—who, when, and why? Can J Psychiatry 2014; 59: 120–30.
17Sánchez-Gistau, V, Colom, F, Mane, A, Romero, S, Sugranyes, G, Vieta, E. Atypical depression is associated with suicide attempt in bipolar disorder. Acta Psychiatr Scand 2009; 120: 30–6.
18Baldessarini, RJ, Innamorati, M, Erbuto, D, Serafini, G, Fiorillo, A, Amore, M, et al. Differential associations of affective temperaments and diagnosis of major affective disorders with suicidal behavior. J Affect Disord 2017; 210: 1921.
19Vázquez, GH, Gonda, X, Lolich, M, Tondo, L, Baldessarini, RJ. Suicidal risk and affective temperaments evaluated with TEMPS-A. Harv Rev Psychiatry 2018; 26: 818.
20Saunders, KE, Hawton, K. Clinical assessment and crisis intervention for the suicidal bipolar disorder patient. Bipolar Disord 2013; 15: 575–83.
21Saunders, KE, Hawton, K. Suicidal behaviour in bipolar disorder: understanding the role of affective states. Bipolar Disord 2015; 17: 24–6.
22Akiskal, HS, Benazzi, F. Psychopathologic correlates of suicidal ideation in major depressive outpatients: is it all due to unrecognized (bipolar) depressive mixed states? Psychopathology 2005; 38: 273–80.
23Vázquez, GH, Lolich, M, Cabrera, C, Jokic, R, Kolar, D, Tondo, L, et al. Mixed symptoms in mood disorders: a systematic review. J Affect Disord 2018; 250: 756–60.
24Diler, RS, Goldstein, TR, Hafeman, D, Merranko, J, Liao, F, Goldstein, BI, et al. Distinguishing bipolar depression from unipolar depression in youth: preliminary findings. J Child Adolesc Psychopharmacol 2017; 27: 310–9.
25Perugi, G, Angst, J, Azorin, JM, Bowden, CL, Mosolov, S, Reis, J, et al. Mixed features in patients with a major depressive episode: the BRIDGE-II-MIX study. J Clin Psychiatry 2015; 76: e3518.
26Bradvik, L. Violent and nonviolent methods of suicide: different patterns may be found in men and women with severe depression. Arch Suicide Res 2007; 11: 255–64.
27Misson, H, Mathieu, F, Jollant, F, Yon, L, Guillaume, S, Parmentier, C, et al. Factor analyses of the Suicidal Intent Scale (SIS) and the Risk-Rescue Rating Scale (RRRS): toward the identification of homogeneous subgroups of suicidal behaviors. J Affect Disord 2010; 121: 80–7.
28Forsman, J, Masterman, T, Ahlner, J, Isacsson, G, Hedstrom, AK. Selective serotonin re-uptake inhibitors and the risk of violent suicide: a nationwide postmortem study. Eur J Clin Pharmacol 2019; 75: 393400.
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Suicidal risk factors in major affective disorders

  • Ross J. Baldessarini (a1), Leonardo Tondo (a2), Marco Pinna (a3), Nicholas Nuñez (a4) and Gustavo H. Vázquez (a5)...
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