Are comorbid anxiety disorders a risk factor for suicide attempts in patients with mood disorders? A two-year prospective study

Development and validation of a nomogram for suicide attempts in patients with first-episode drug-naïve major depressive disorder

Objective

The risk of suicide can be decreased by accurately identifying high-risk suicide groups and implementing the right interventions. The aim of this study was to develop a nomogram for suicide attempts (SA) in patients with first-episode drug-naïve (FEDN) major depressive disorder (MDD).

Methods

This study undertook a cross-sectional analysis of 1,718 patients diagnosed with FEDN MDD, providing comprehensive clinical data from September 2016 to December 2018. Data on anthropometric and sociodemographic factors were gathered, and the severity of depression and anxiety was evaluated using the 17-item Hamilton Depression Scale (HAMD-17) and the Hamilton Anxiety Scale (HAMA), respectively. Additionally, thyroid hormone levels, lipid profile parameters, and fasting blood glucose (FBG) were measured. Suicide attempt (SA) history was verified based on an amalgamation of medical records, patient interviews, and family interviews. Participants were randomly divided into a training group (70%, n = 1,204) and a validation group (30%, n = 514). In the training group, LASSO analysis and multivariate regression were used to identify variables associated with SA. A nomogram was then constructed using the identified risk factors to estimate the likelihood of SA within the training group. To assess the accuracy, the area under the receiver operating characteristic curve (AUC) was utilized, and calibration plots were employed to evaluate calibration. Additionally, decision curve analysis (DCA) was performed to assess the precision of the model. Finally, internal validation was carried out using the validation group.

Results

A practical nomogram has been successfully constructed, incorporating HAMD, HAMA, thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), and systolic blood pressure (SBP) parameters, to estimate the probability of SA in Chinese patients diagnosed with FEDN MDD. The pooled area under the ROC for SA risk in both the training and validation groups was found to be 0.802 (95% CI: 0.771 to 0.832) and 0.821 (95% CI: 0.774 to 0.868), respectively. Calibration analysis revealed a satisfactory correlation between the nomogram probabilities and the actual observed probabilities. The clinical applicability of the nomogram was confirmed through decision curve analysis. To enhance accessibility for clinicians and researchers, an online version of the nomogram can be accessed at https://doctorjunjunliu.shinyapps.io/dynnomapp/.

Conclusions

We constructed and validated a nomogram for the early detection of FEDN MDD patients with a high risk of SA, thereby contributing to the implementation of effective suicide prevention programs.

Molecular Changes Associated with Suicide

Suicide is a serious global public health problem, with a worrying recent increase in suicide rates in both adolescent and adult populations. However, it is essential to recognize that suicide is preventable. A myriad of factors contributes to an individual's vulnerability to suicide. These factors include various potential causes, from psychiatric disorders to genetic and epigenetic alterations. These changes can induce dysfunctions in crucial systems such as the serotonergic, cannabinoid, and hypothalamic-pituitary-adrenal axes. In addition, early life experiences of abuse can profoundly impact an individual's ability to cope with stress, ultimately leading to changes in the inflammatory system, which is a significant risk factor for suicidal behavior. Thus, it is clear that suicidal behavior may result from a confluence of multiple factors. This review examines the primary risk factors associated with suicidal behavior, including psychiatric disorders, early life adversities, and epigenetic modifications. Our goal is to elucidate the molecular changes at the genetic, epigenetic, and molecular levels in the brains of individuals who have taken their own lives and in the plasma and peripheral mononuclear cells of suicide attempters and how these changes may serve as predisposing factors for suicidal tendencies.

Suicidal risk and protective factors in major affective disorders: A prospective cohort study of 4307 participants

BACKGROUND

Suicidal behavior is strongly associated with major affective disorders, but there is a need to quantify and compare specific risk and protective factors in bipolar disorder (BD) and major depressive disorder (MDD).

METHODS

In 4307 extensively evaluated major affective-disorder participants with BD (n = 1425) or MDD (n = 2882) diagnosed by current international criteria, we compared characteristics among those with versus without suicidal acts from illness-onset through 8.24 years of follow-up.

RESULTS

Suicidal acts were identified in 11.4 % of participants; 25.9 % were violent and 6.92 % (0.79 % of all participants) were fatal. Associated risk factors included: diagnosis (BD > MDD), manic/psychotic features in first-episodes, family history of suicide or BD, separation/divorce, early abuse, young at illness-onset, female sex with BD, substance abuse, higher irritable, cyclothymic or dysthymic temperament ratings, greater long-term morbidity, and lower intake functional ratings. Protective factors included marriage, co-occurring anxiety disorder, higher ratings of hyperthymic temperament and depressive first episodes. Based on multivariable logistic regression, five factors remained significantly and independently associated with suicidal acts: BD diagnosis, more time depressed during prospective follow-up, younger at onset, lower functional status at intake, and women > men with BD.

LIMITATIONS

Reported findings may or may not apply consistently in other cultures and locations.

CONCLUSIONS

Suicidal acts including violent acts and suicides were more prevalent with BD than MDD. Of identified risk (n = 31) and protective factors (n = 4), several differed with diagnosis. Their clinical recognition should contribute to improved prediction and prevention of suicide in major affective disorders.

Vitamin D and suicidality: a Chinese early adolescent cohort and Mendelian randomization study

AIMS

Previous cross-sectional and case-control studies have proposed that decreased vitamin D levels are positively correlated with the risk of suicidality in adults. However, limited studies have examined the association between vitamin D and suicidality in adolescents. This study aimed to investigate the relationship between serum vitamin D and suicidality risk among early adolescents.

METHODS

Data were obtained from a Chinese early adolescent cohort. In this cohort, seventh-grade students from a middle school in Anhui Province were invited to voluntarily participate in the baseline assessments and provide peripheral blood samples (in September 2019). The participants were followed up annually (in September 2020 and September 2021). Serum 25-hydroxyvitamin D [25(OH)D] and vitamin D-related single-nucleotide polymorphisms at baseline were measured in November 2021. Traditional observational and Mendelian randomization (MR) analyses were performed to examine the relationship between serum 25(OH)D at baseline and the risk of baseline and incident suicidality (i.e., suicidal ideation [SI], plans and attempts).

RESULTS

Traditional observational analysis did not reveal a significant linear or non-linear association of serum 25(OH)D concentration with the risks of baseline and 2-year incident suicidality in the total sample (P > .05 for all). Sex-stratified analysis revealed a non-linear association between the 25(OH)D concentration and the risk of baseline SI in women (Poverall = .002; Pnon-linear = .001). Moreover, the risk of baseline SI in the 25(OH) insufficiency group was lower than that in the 25(OH) deficiency group in the total sample (odds ratio [OR] = 0.69, 95% confidence interval [CI] = 0.51-0.92, P = .012). This difference remained significant in women (OR = 0.59, 95% CI = 0.40-0.87, P = .008) but not in men (OR = 0.78, 95% CI = 0.53-1.15, P = .205). Additionally, both linear and non-linear MR analyses did not support the causal effect of serum 25(OH)D concentration on the risk of baseline, 1-year and 2-year incident suicidality (P > .05 for all).

CONCLUSIONS

This study could not confirm the causal effect of vitamin D on suicidality risk among Chinese early adolescents. Future studies must confirm these findings with a large sample size.

Prevalence and influencing factors of suicide in first-episode and drug-naive young major depressive disorder patients with impaired fasting glucose: a cross-sectional study

Background

An association exists between major depression disorder (MDD), suicide attempts, and glucose metabolism, but suicide attempts in young MDD patients with comorbid impaired fasting glucose (IFG) have been less well studied. The purpose of this study was to examine the prevalence and risk factors for suicide attempts in young, first-episode, drug-naive (FEDN) MDD patients with comorbid IFG.

Methods

We recruited 917 young patients with FEDN MDD, 116 of whom were judged to have combined IFG because their blood glucose was >6.0. We collected anthropological and clinical data on all of them. The Hamilton Depression Scale (HAMD) score, the Hamilton Anxiety Scale (HAMA) score and the Positive and Negative Syndrome Scale (PANSS) positive subscale score were used to assess their clinical symptoms. Blood glucose, plasma thyroid function and lipid indicators were measured.

Results

The prevalence of suicide attempts in young MDD patients with IFG was 32.8% (38/116). Furthermore, among young MDD patients with comorbid IFG, suicide attempters had more severe depression and anxiety symptoms, more comorbid psychotic symptom, higher levels of antibody of thyroid stimulating hormone and thyroid peroxidases (TPOAb), and more severe lipid metabolism disorders than those without suicide attempts. In addition, HAMA scores and TPOAb were independently associated with suicide attempts in young patients with FEDN MDD.

Conclusion

Our study suggests that young MDD patients with IFG have a high rate of suicide attempts. Some clinical symptoms and thyroid function parameters may be the risk factor for suicide attempts in young MDD patients with impaired glucose metabolism.

High Rates of Anxiety Among Adolescents in a Partial Hospitalization Program

Background

Anxiety disorders are garnering increasing attention for their contribution to high-risk issues and functional impairment. Adolescents are typically admitted to partial hospitalization programs (PHPs) due to high-risk presentations. However, the frequency of anxiety disorders in PHPs is not well-established, in part because anxiety can be overlooked in acute settings due to limited lengths of stay and focus on stabilization.

Objective

This study aims to evaluate the frequency and severity of anxiety disorders among a sample of adolescent PHP patients to assess the need for anxiety-specific assessment and interventions in higher acuity settings.

Methods

Participants were 158 youths ages 13 to 19 years old (M = 15.49 years, SD = 1.50) who were admitted to an adolescent PHP and their caregivers. Clinician-reported diagnostic information was collected from the youth's electronic medical record, and self- and caregiver-rated severity of anxiety was collected using the Screen for Child Anxiety Related Emotions Disorders (SCARED-C/P). Frequency of anxiety and related disorder diagnoses and self- and caregiver-reported severity were assessed using descriptive statistical methods.

Results

75% of participants were diagnosed with an anxiety disorder (n = 118). On average, participants with anxiety disorders had elevated SCARED-C scores. Youths with depressive disorders had elevated SCARED-C scores even when they did not carry anxiety disorder diagnoses. Caregiver ratings of the youth's anxiety symptoms on the SCARED-P were elevated when youths had anxiety disorders.

Conclusions

These findings suggest that anxiety is common in an adolescent PHP setting and support investing in evidence-based assessment and treatment of anxiety in high-acuity settings.

Perceived stress and life satisfaction among elderly migrants in China: A moderated mediation model

Objective

Our study aims to test whether anxiety mediated the association between perceived stress and life satisfaction and whether the mediating effect was moderated by resilience among elderly migrants in China.

Methods

We used self-reported data collected from 654 elderly migrants in Nanjing. Regression analyses using bootstrapping methods were conducted to explore the mediating and moderating effects.

Results

The results showed that anxiety mediated the relationship between perceived stress and life satisfaction (indirect effect = -0.040, CI [-0.066, -0.017]). Moreover, moderated mediated analysis indicated that resilience moderated the path between anxiety and life satisfaction (moderating effect = 0.034, 95% CI [0.021, 0.048]). In particular, anxiety had a negative impact on life satisfaction only for Chinese elderly migrants with lower resilience.

Conclusion

Our study suggests that perceived stress could reduce life satisfaction among elderly migrants as their anxiety levels increase. Fortunately, elderly migrants' resilience could undermine this negative effect.

Predictive Model of Suicide Risk in Young People: The Mediating Role of Alcohol Consumption

Suicidal behavior is one of the public health problems that cause most deaths in young people and has been associated with emotional and affective problems, so predictive models are required to account for the relationship between depression, anxiety, hopelessness, and alcohol consumption to propose actions for its prevention. The Plutchik Suicide Risk Scale, the CAGE Questionnaire, the Hopelessness Scale, the Depression Inventory and the Beck Anxiety Scale were applied. A total of 1.379 young people (M = 20.45; SD = 3.23) from the cities of Manizales (n = 739; 53.6%) and Medellín (n = 640; 46.5%) in Colombia were evaluated. The variables of anxiety, hopelessness and depression explained 51% (R² = 0.509; 95% CI = 0.467-0.552; p = 0.001) of the variation in suicidal risk. Likewise, alcohol consumption is a mediating variable between depression and anxiety in the prediction of suicidal risk, whose total, direct and indirect effects are statistically significant. The findings support the role of alcohol consumption as a mediating variable between anxiety, depression, hopelessness and suicidal risk in young people, given the difficulties it causes in information processing, regulation of emotions and therefore in having an adequate coping with the demands of the environment. This justifies the importance of directing suicide prevention actions through strategies for the reduction of alcohol consumption and the management of emotions in young people. HIGHLIGHTSAlcohol modulates the effect of depression and anxiety on suicide riskThis is a study on the risk of suicide in young people in ColombiaThe findings have implications for timely clinical interventions.

Mechanisms Underlying the Anti-Suicidal Treatment Potential of Buprenorphine

Death by suicide is a global epidemic with over 800 K suicidal deaths worlwide in 2012. Suicide is the 10th leading cause of death among Americans and more than 44 K people died by suicide in 2019 in the United States. Patients with chronic pain, including, but not limited to, those with substance use disorders, are particularly vulnerable. Chronic pain patients have twice the risk of death by suicide compared to those without pain, and 50% of chronic pain patients report that they have considered suicide at some point due to their pain. The kappa opioid system is implicated in negative mood states including dysphoria, depression, and anxiety, and recent evidence shows that chronic pain increases the function of this system in limbic brain regions important for affect and motivation. Additionally, dynorphin, the endogenous ligand that activates the kappa opioid receptor is increased in the caudate putamen of human suicide victims. A potential treatment for reducing suicidal ideation and suicidal attempts is buprenorphine. Buprenorphine, a partial mu opioid agonist with kappa opioid antagonist properties, reduced suicidal ideation in chronic pain patients with and without an opioid use disorder. This review will highlight the clinical and preclinical evidence to support the use of buprenorphine in mitigating pain-induced negative affective states and suicidal thoughts, where these effects are at least partially mediated via its kappa antagonist properties.

The Association Between the 5Cs and Anxiety-Insights From Three Countries: Portugal, Slovenia, and Spain

Several of the most frequent psychological difficulties in childhood and adolescence are related to anxiety and lead to numerous short- and long-term negative outcomes in emotional, social, and academic domains. Empirical evidence consistently shows that the 5Cs (competence, caring, confidence, connection, and character) of Positive Youth Development (PYD) are positively related to adolescents’ contribution to self, family, and society as well as negatively related to risky behaviors and emotional difficulties, such as anxiety. Thus, the PYD can be one of the models that informs prevention programs. To provide contextualized, data-driven support for prevention efforts, we have analyzed the predictive value of the 5Cs for anxiety and anxiety dimensions using three different convenience youth samples from Portugal (N = 384, 46.6% female), Slovenia (N = 449, 69% females), and Spain (N = 768; 60.5% females). To assess the 5Cs, we used the same short form of the PYD scale in all samples (Geldhof et al., 2013) and different anxiety measures across samples: the Multidimensional Anxiety Scale for Children (MASC) in Portugal, the Lestvica anksioznosti za otroke in mladostnike anxiety scale (LAOM) in Slovenia and the Generalized Anxiety Disorder-7 (GAD-7) in Spain. The findings show significant associations of PYD and anxiety across all three contexts with all three different anxiety measures used. The associations vary across countries emphasizing the need to further research the role of contexts in anxiety prevention. Despite variations the results do indicate that connection is negatively associated with anxiety in all three contexts using the three anxiety measures, while confidence is a negative predictor and caring is a positive predictor of anxiety in Slovenia and Spain. Implications for practice within an educational framework for adolescents and youth are discussed, together with public policy recommendations.

Prevalence, course, and determinants of suicide ideation and attempts in patients with a depressive and/or anxiety disorder: A review of NESDA findings

BACKGROUND

Depressive and anxiety disorders are often associated with suicide ideation (SI) and attempt (SA). However, analyses of prevalence, course, and more specific risk mechanisms are needed to improve knowledge and detection of high risk individuals with depressive and anxiety disorders. Previous studies often lacked statistical power, assessment of detailed determinants and follow-up measurements.

METHODS

The Netherlands Study of Depression and Anxiety (NESDA), a large cohort study, overcomes some earlier limitations. Scale for Suicide Ideation and Compositive Interview Diagnostic Instrument data were analyzed to report on prevalence of SI and SA. Additionally, important sociodemographic, clinical, psychological, environmental, and neurobiological determinants and course of SI and SA identified in depressive and/or anxiety disorder respondents in 16 NESDA articles were summarized.

RESULTS

Within respondents with 12-month diagnosis (n=1,783), SI and 12-month SA prevalence ranged from 17.1-20.1% and 0.8-3.0% respectively across 5 waves during 9-year follow-up and SI was highly recurrent. Both SI and SA were especially associated with comorbid depression and anxiety, higher clinical severity, sleep dysfunctions, higher aggression and hopelessness, and childhood trauma. In the (neuro)biological domain, SI was linked with immune dysregulation and SA with abnormal brain activity during emotion processing and genetic risk.

LIMITATIONS

Most articles were cross-sectional in nature, preventing causal inferences and no conclusions could be drawn about the overall magnitude of results.

CONCLUSION

SI and SA are multifactorial phenomena and especially prevalent amongst comorbid depressive and anxiety respondents. Considering many overlapping SI and SA determinants, more neurobiological determinants and use of innovative methodological techniques are desirable.

The association of clinical correlates, metabolic parameters, and thyroid hormones with suicide attempts in first-episode and drug-naïve patients with major depressive disorder comorbid with anxiety: a large-scale cross-sectional study

The associated factors of suicide attempts in patients with major depressive disorder (MDD) comorbid with anxiety remains unclear. To the best of our knowledge, this is the first study with a large sample size that examines the risk factors of suicide attempts in first-episode drug-naïve (FEND) MDD patients comorbid with anxiety and includes clinical correlates, metabolic parameters, and thyroid hormone levels. A total of 1718 FEDN MDD patients were enrolled. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) were used to assess the symptoms of patients. Metabolic parameters and thyroid hormone levels were measured. The prevalence of suicide attempts in MDD patients comorbid anxiety symptoms was 24.28%, which was 9.51 times higher than that in MDD patients without anxiety symptoms (3.25%). Compared to non-attempters, MDD patients with anxiety symptoms who attempted suicide scored higher on HAMD and HAMA, and had higher systolic blood pressure, higher levels of thyroid stimulating hormone (TSH), and thyroid peroxidases antibody (TPOAb), which were also correlated with suicide attempts in MDD patients comorbid anxiety symptoms. The combination of HAMA score, HAMD score, and TSH could differentiate suicide attempters from non-suicide attempters. Further, the age of onset, illness duration, BMI, TSH, and TPOAb were associated with the times of suicide attempts in MDD patients comorbid anxiety symptoms. Our results demonstrate high prevalence of suicide attempts in MDD patients comorbid anxiety symptoms. Several clinical correlates, metabolic parameters, and thyroid hormones function contribute to the suicide attempts in MDD patients comorbid anxiety symptoms.

A Naturalistic Study of Youth Referred to a Tertiary Care Facility for Acute Hypomanic or Manic Episode

Background: Bipolar Disorders (BD) in youth are a heterogeneous condition with different phenomenology, patterns of comorbidity and outcomes. Our aim was to explore the effects of gender; age at onset (prepubertal- vs. adolescent-onset) of BD; and elements associated with attention deficit hyperactivity disorder (ADHD) and Substance Use Disorder (SUD) comorbidities, severe suicidal ideation or attempts, and poorer response to pharmacological treatments. Method: 117 youth (69 males and 57 females, age range 7 to 18 years, mean age 14.5 ± 2.6 years) consecutively referred for (hypo)manic episodes according to the Diagnostic and Statistical Manual of Mental Disorders, 54th ed (DSM 5) were included. Results: Gender differences were not evident for any of the selected features. Prepubertal-onset BD was associated with higher rates of ADHD and externalizing disorders. SUD was higher in adolescent-onset BD and was associated with externalizing comorbidities and lower response to treatments. None of the selected measures differentiated patients with or without suicidality. At a 6-month follow up, 51.3% of the patients were responders to treatments, without difference between those receiving and not receiving a psychotherapy. Clinical severity at baseline and comorbidity with Conduct Disorder (CD) and SUD were associated with poorer response. Logistic regression indicated that baseline severity and number of externalizing disorders were associated with a poorer outcome. Conclusions: Disentangling broader clinical conditions in more specific phenotypes can help timely and focused preventative and therapeutic interventions.

Development of the short version of the spielberger state-trait anxiety inventory

The Spielberger State-Trait Anxiety Inventory (STAI) has been widely used to measure the state and trait components of anxiety. We sought to develop a short, yet reliable and valid form of these scales for use in circumstances where the full-form is not feasible. We abbreviated the scales using item response theory analyses to retain the items that could discriminate the best among participants. One sample (N = 922) completed the state scale, a second sample (N = 2227) completed the trait scale, while a third sample (N = 250) completed the short forms. Our participants completed the Hungarian version of STAI alongside other measures to observe external validity. We calculated cut-off scores for the state (>9.5,) and trait (>13.5) scales. A total of 19.5% and 20.1% of the respondents reached the cut-off scores. The five-item short forms of STAI had sound psychometric properties that are comparable to those obtained on the full-form. The external validity of the scales is also demonstrated. We report detailed descriptive statistics that could be used in further studies as standards. The short scales are reliable measures that could be used in clinical screening and behavioural research; especially where practical considerations preclude the use of a longer questionnaire.

Understanding the Complex of Suicide in Depression: from Research to Clinics

OBJECTIVE

Amongst psychiatric disorders, major depressive disorder (MDD) is the most prevalent, by affecting approximately 15-17% of the population and showing a high suicide risk rate equivalent to around 15%. The present comprehensive overview aims at evaluating main research studies in the field of MDD at suicide risk, by proposing as well as a schematic suicide risk stratification and useful flow-chart for planning suicide preventive and therapeutic interventions for clinicians.

METHODS

A broad and comprehensive overview has been here conducted by using PubMed/Medline, combining the search strategy of free text terms and exploded MESH headings for the topics of 'Major Depressive Disorder' and 'Suicide' as following: ((suicide [Title/Abstract]) AND (major depressive disorder [Title/Abstract])). All articles published in English through May 31, 2019 were summarized in a comprehensive way.

RESULTS

Despite possible pathophysiological factors which may explain the complexity of suicide in MDD, scientific evidence supposed the synergic role of genetics, exogenous and endogenous stressors (i.e., interpersonal, professional, financial, as well as psychiatric disorders), epigenetic, the hypothalamic-pituitary-adrenal stress-response system, the involvement of the monoaminergic neurotransmitter systems, particularly the serotonergic ones, the lipid profile, neuro-immunological biomarkers, the Brain-derived neurotrophic factor and other neuromodulators.

CONCLUSION

The present overview reported that suicide is a highly complex and multifaceted phenomenon in which a large plethora of mechanisms could be variable implicated, particularly amongst MDD subjects. Beyond these consideration, modern psychiatry needs a better interpretation of suicide risk with a more careful assessment of suicide risk stratification and planning of clinical and treatment interventions.

Development of an early-warning system for high-risk patients for suicide attempt using deep learning and electronic health records

Suicide is the tenth leading cause of death in the United States (US). An early-warning system (EWS) for suicide attempt could prove valuable for identifying those at risk of suicide attempts, and analyzing the contribution of repeated attempts to the risk of eventual death by suicide. In this study we sought to develop an EWS for high-risk suicide attempt patients through the development of a population-based risk stratification surveillance system. Advanced machine-learning algorithms and deep neural networks were utilized to build models with the data from electronic health records (EHRs). A final risk score was calculated for each individual and calibrated to indicate the probability of a suicide attempt in the following 1-year time period. Risk scores were subjected to individual-level analysis in order to aid in the interpretation of the results for health-care providers managing the at-risk cohorts. The 1-year suicide attempt risk model attained an area under the curve (AUC ROC) of 0.792 and 0.769 in the retrospective and prospective cohorts, respectively. The suicide attempt rate in the "very high risk" category was 60 times greater than the population baseline when tested in the prospective cohorts. Mental health disorders including depression, bipolar disorders and anxiety, along with substance abuse, impulse control disorders, clinical utilization indicators, and socioeconomic determinants were recognized as significant features associated with incident suicide attempt.

Are quantity and content of psychiatric interventions associated with suicide? A case-control study of a Swedish sample

BACKGROUND

Research is required to identify those psychiatric interventions with a protective effect against suicide. The overarching aim of the current study was to examine whether completed suicide in psychiatric patients in a Swedish population was associated with the quantity and nature of previous medical and psychosocial treatment interventions.

METHODS

This retrospective case-control study (n = 308) compared a group of deceased psychiatric patients with matched controls. For every case of suicide, a control was found within psychiatry that matched according to sex, age, and primary psychiatric diagnosis. A stepwise forward logistic regression model with suicide as the dependent outcome variable was used.

RESULTS

Receiving pharmacotherapy combined with psychotherapy [OR: 0.44 (95% CI: 0.226-0.876), p = 0.019] and a higher number of outpatient visits in psychiatry [OR: 0.99 (95% CI: 0.982-0.999), p = 0.028] were negatively associated with suicide. These associations were still significant after controlling for previous serious suicide attempts and somatic comorbidity.

CONCLUSIONS

Frequent visits and pharmacotherapy combined with psychotherapy seem to be important for preventing suicide in psychiatric patients. The reasons for not receiving such therapy are important issues for further study.

Modelling suicide ideation from beep to beep: Application of network analysis to ecological momentary assessment data

•EMA data were analyzed using network analysis (e.g., temporal networks).•Suicidal ideation at t was predicted by itself and perceived burdensomeness at t - 1.•Suicidal ideation at t - 1 predicted perceived burdensomeness, depression etc. at t.•At the same beep, suicidal ideation was related to all variables in the network.•Patients with higher average suicidal ideation had higher average hopelessness.

The longitudinal association between lifetime mental disorders and first onset or recurrent suicide ideation

BACKGROUND

Although the cross-sectional association between mental disorders and suicide ideation is well studied, less is known about the prospective association. In this paper, we estimated among those without 12-month suicide ideation at baseline, the association between a wide variety of common mental disorders at baseline and suicide ideation within the 6-year follow-up period, after controlling for history of other mental disorders and demographic variables.

METHODS

Data were used from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a prospective representative adult cohort study with baseline (n = 6646) with a 6-year follow-up period. Lifetime mental disorders were assessed at baseline with the Composite International Diagnostic Interview 3.0. Within the longitudinal design, participants with first time or recurrent suicide ideation were defined follows: having no suicide ideation in the 12 months before the baseline assessment, and reporting to have had seriously thought about suicide between baseline and the 6-year follow-up period. Multiple logistical regression was used to estimate the longitudinal association between suicide ideation and a specific mental disorder while controlling for comorbidity and baseline variables. To account for the prevalence of a disorder in the population, for each disorder, the population attributable risk proportion (PARP) was calculated.

RESULTS

2.9% (n = 132) of the participants that did not report suicide ideation in the past 12 months at baseline reported suicide ideation at follow-up. Of these 132 cases, 81 (61%) experienced suicide ideation for the first time in their lives and could be viewed as first onset cases. 51 (39%) reported recurrent suicide ideation. After controlling for comorbidity, the only two disorders that were significantly related to suicide ideation at follow-up were lifetime major depressive disorder (MDD) and generalized anxiety disorder (GAD). PARP for MDD was 47.8 and 16.6% for GAD.

CONCLUSIONS

After controlling for all other mental disorders, a lifetime history of MDD and GAD were related to suicide ideation at follow-up. For clinical practice, this indicates that patients with a history of MDD or GAD stay vulnerable for suicide ideation, even though they did not report suicide ideation in the past year.

Well-being in major depression and social phobia with and without comorbidity

Background/Objective: Lower levels in well-being have been observed in individuals with Major Depression (MDD) and Social Phobia (SP), but well-planned direct comparisons with control individuals, not suffering from a mental disorder, are lacking. Furthermore, MDD is highly comorbid with anxiety disorders, and SP with depressive disorders. This study is among the first to examine differences in well-being in individuals with a clinical diagnosis of MDD or SP compared to individuals with no such diagnosis and to test differences in well-being within the combined diagnostic categories respective with and without anxiety-depressive comorbidity. Method: Participants were 119 individuals with a diagnosis of MDD, 47 SP and 118 controls. Results: Results revealed that overall well-being as well as emotional, psychological, and social well-being were lower in the MDD and SP group compared to the control group. Individuals with comorbidity reported lower well-being than individuals without comorbidity. Conclusions: These findings have clinical implications as presence of comorbidity may require a different therapeutic approach than with no comorbidity.