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Miola A, Tondo L, Pinna M, Contu M, Baldessarini RJ. Suicidal risk and protective factors in major affective disorders: A prospective cohort study of 4307 participants. J Affect Disord 2023; 338:189-198. [PMID: 37301296 DOI: 10.1016/j.jad.2023.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 05/25/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Alessandro Miola
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, United States of America; Department of Neuroscience, University of Padova, Padua, Italy.
| | - Leonardo Tondo
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Lucio Bini Mood Disorder Centers, Cagliari & Rome, Italy
| | - Marco Pinna
- Lucio Bini Mood Disorder Centers, Cagliari & Rome, Italy; Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Martina Contu
- Lucio Bini Mood Disorder Centers, Cagliari & Rome, Italy
| | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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Fatal suicidal behavior in Bipolar II patients after their first hospitalization. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022. [DOI: 10.1016/j.rpsm.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ortiz A, Bradler K, Moorti P, MacLean S, Husain MI, Sanches M, Goldstein BI, Alda M, Mulsant BH. Reduced heart rate variability is associated with higher illness burden in bipolar disorder. J Psychosom Res 2021; 145:110478. [PMID: 33820643 DOI: 10.1016/j.jpsychores.2021.110478] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/16/2021] [Accepted: 03/27/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with premature death and ischemic heart disease is the main cause of excess mortality. Heart rate variability (HRV) predicts mortality in patients with or without cardiovascular disease. While several studies have analyzed the association between HRV and BD, none has analyzed the association of HRV with illness burden in BD. METHODS 53 participants with BD I and II used a wearable device to assess the association between HRV and factors characterizing illness burden, including illness duration, number and type of previous episode(s), duration of the most severe episode, history of suicide attempts or psychotic symptoms during episodes, and co-morbid psychiatric disorders. We ran unadjusted models and models controlling statistically for age, sex, pharmacotherapy, baseline functional cardiovascular capacity, BMI, years of education, and marital status. We also explored the association between HRV and an overall illness burden index (IBI) integrating all these factors using a weighted geometric mean. RESULTS Adjusted and unadjusted models had similar results. Longer illness duration, higher number of depressive episodes, longer duration of most severe manic/hypomanic episode, co-morbid anxiety disorders, and family history of suicide were associated with reduced HRV, as was bipolar depression severity in the participants experiencing a depressive episode. Finally, a higher IBI score was associated with lower HRV. CONCLUSIONS High illness burden is associated with reduced HRV in BD. While the IBI needs to be validated in a larger sample, it may provide an overall measure that captures illness burden in BD.
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Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | | | - Pooja Moorti
- Institute for Mental Health Research, The Royal Ottawa Hospital, Ottawa, ON, Canada
| | - Stephane MacLean
- Institute for Mental Health Research, The Royal Ottawa Hospital, Ottawa, ON, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Marcos Sanches
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada; National Institute of Mental Health, Klecany, Czech Republic
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
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Completed suicide in bipolar disorder patients: A cohort study after first hospitalization. J Affect Disord 2019; 257:340-344. [PMID: 31302523 DOI: 10.1016/j.jad.2019.07.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/08/2019] [Accepted: 07/04/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is a mental health condition that has one of the greatest risk of completed suicide (CS). Hospitalization in affective disorders is associated with increased illness severity and suicide risk, so the study of suicide after the first hospitalization is of special interest. METHOD We studied a retrospective cohort consisting on all BD type I (BD-I) and II (BD-II) (according to DSM-IV criteria) admitted for the first time in their lives to the psychiatry unit of a general hospital between 1996 and 2016 from an area in Catalonia (Spain). All patients were also followed-up in a community center of mental health as outpatients until the end of 2017. Multiple variables were prospectively collected during the first hospital admission and were compared between patients who CS and those who did not. RESULTS 14 of 313 (4.5%) bipolar patients included CS during the 11-year follow-up, and 93% used a violent method. In the univariate analysis we found that Bipolar II Disorder, treatment with antidepressants and/or with lamotrigine were associated with higher risk of CS, however, treatment with valproate and/or with antipsychotics were associated with lower risk of CS . After logistic regression multivariant analysis, only immediately previous violent suicide attempt and first-degree family history of CS remain significant risk factors of CS. A limitation is the relatively small sample from a local hospital and followed locally. CONCLUSION Followed during an average of 11 years after the first hospital admission, Bipolar patients completed suicide at a rate 58 times higher than the general population and almost always performed through a violent method. Violent attempted suicide before admission and first- degree family history of CS, are clear and potent predictors of completed suicide.
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Association of symptoms of attention deficit-hyperactivity disorder and impulsive-aggression with severity of suicidal behavior in adult attempters. Sci Rep 2019; 9:4593. [PMID: 30872743 PMCID: PMC6418227 DOI: 10.1038/s41598-019-41046-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/19/2019] [Indexed: 01/28/2023] Open
Abstract
Literature emphasizes the relationship between attention deficit-hyperactivity disorder (ADHD) and suicidal behavior (SB). However, the link between ADHD and the severity of SB is yet to be determined. We investigated the association between a probable diagnosis of ADHD and the severity of SB in 539 hospitalized suicide attempters, and determined the role of comorbid psychiatric diagnoses. The severity of SB was defined as the number of suicide attempts, age at first suicide attempt, seriousness and violence of suicide attempts. A diagnosis of probable adult ADHD (probable ADHD) was defined as the presence of both current ADHD symptoms and ADHD symptoms in childhood. We evaluated the combined effect of high impulsive-aggression levels and probable ADHD. Probable ADHD was not associated with early or frequent suicide attempts after adjustment for psychiatric disorders and treatment intake. High levels of impulsive-aggression increased the risk of an early suicide attempt, particularly in patients with ADHD symptoms, and independently of other clinical factors. The association between serious suicide attempts and probable ADHD remained significant after adjustment. Although ADHD is involved in suicidal vulnerability, psychiatric comorbidities and impulsive-aggression appear to largely explain the severity of SB in adult attempters with ADHD symptoms.
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Abstract
The association of lifetime suicidal behaviors with anxiety disorders (ADs) in patients with bipolar disorder (BD) has been controversial. In this study, we hypothesized that certain types of ADs were related to the occurrence of past suicide attempts (SAs) independent of the severity of the BD, including the presence of past affective episodes. Lifetime diagnoses of BD and ADs were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Disorders (SCID-I). Of the total sample of 200 patients with BD, 32.0% had at least 1 past SA. The mean number of previous hospitalizations, a history of social AD, and a history of posttraumatic stress disorder were strongly associated with past SAs in patients with bipolar I disorder. The presence of lifetime social AD was associated with lifetime SAs independent of previous depressive episodes. Therefore, we suggest that social AD itself is associated with a greater risk for SAs in patients with BD independent of the presence of depression.
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Onset polarity in bipolar disorder: A strong association between first depressive episode and suicide attempts. J Affect Disord 2017; 209:182-187. [PMID: 27936451 DOI: 10.1016/j.jad.2016.11.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/22/2016] [Accepted: 11/28/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The role of onset polarity (OP) in patients with bipolar disorder (BD) has been increasingly investigated over the last few years, for its clinical, prognostic, and therapeutic implications. The present study sought to assess whether OP was associated with specific correlates, in particular with a differential suicidal risk in BD patients. METHODS A sample of 362 recovered BD patients was dichotomized by OP: depressed (DO) or elevated onset (EO: hypomanic/manic/mixed). Socio-demographic and clinical variables were compared between the subgroups. Additionally, binary logistic regression was performed to assess features associated with OP. RESULTS DO compared with EO patients had older current age and were more often female, but less often single and unemployed. Clinically, DO versus EO had a more than doubled rate of suicide attempts, as well as significantly higher rates of BD II diagnosis, lifetime stressful events, current psychotropics and antidepressants use, longer duration of the most recent episode (more often depressive), but lower rates of psychosis and involuntary commitments. LIMITATIONS Retrospective design limiting the accurate assessment of total number of prior episodes of each polarity. CONCLUSIONS Our results support the influence of OP on BD course and outcome. Moreover, in light of the relationship between DO and a higher rate of suicide attempts, further investigation may help clinicians in identifying patients at higher risk of suicide attempts.
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Schaffer A, Isometsä ET, Azorin JM, Cassidy F, Goldstein T, Rihmer Z, Sinyor M, Tondo L, Moreno DH, Turecki G, Reis C, Kessing LV, Ha K, Weizman A, Beautrais A, Chou YH, Diazgranados N, Levitt AJ, Zarate CA, Yatham L. A review of factors associated with greater likelihood of suicide attempts and suicide deaths in bipolar disorder: Part II of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder. Aust N Z J Psychiatry 2015; 49:1006-20. [PMID: 26175498 PMCID: PMC5858693 DOI: 10.1177/0004867415594428] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Many factors influence the likelihood of suicide attempts or deaths in persons with bipolar disorder. One key aim of the International Society for Bipolar Disorders Task Force on Suicide was to summarize the available literature on the presence and magnitude of effect of these factors. METHODS A systematic review of studies published from 1 January 1980 to 30 May 2014 identified using keywords 'bipolar disorder' and 'suicide attempts or suicide'. This specific paper examined all reports on factors putatively associated with suicide attempts or suicide deaths in bipolar disorder samples. Factors were subcategorized into: (1) sociodemographics, (2) clinical characteristics of bipolar disorder, (3) comorbidities, and (4) other clinical variables. RESULTS We identified 141 studies that examined how 20 specific factors influenced the likelihood of suicide attempts or deaths. While the level of evidence and degree of confluence varied across factors, there was at least one study that found an effect for each of the following factors: sex, age, race, marital status, religious affiliation, age of illness onset, duration of illness, bipolar disorder subtype, polarity of first episode, polarity of current/recent episode, predominant polarity, mood episode characteristics, psychosis, psychiatric comorbidity, personality characteristics, sexual dysfunction, first-degree family history of suicide or mood disorders, past suicide attempts, early life trauma, and psychosocial precipitants. CONCLUSION There is a wealth of data on factors that influence the likelihood of suicide attempts and suicide deaths in people with bipolar disorder. Given the heterogeneity of study samples and designs, further research is needed to replicate and determine the magnitude of effect of most of these factors. This approach can ultimately lead to enhanced risk stratification for patients with bipolar disorder.
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Affiliation(s)
- Ayal Schaffer
- Task Force on Suicide, The International Society for Bipolar Disorders (ISBD), Pittsburgh, PA, USA; Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Erkki T Isometsä
- Department of Psychiatry, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | - Jean-Michel Azorin
- Department of Adult Psychiatry, Sainte Marguerite Hospital, Marseille, France; University of Aix-Marseille II, Marseille, France
| | - Frederick Cassidy
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioural Sciences, Duke University, Durham, NC, USA
| | - Tina Goldstein
- Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zoltán Rihmer
- Department of Clinical and Theoretical Mental Health, and Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Leonardo Tondo
- Lucio Bini Center, Cagliari, Italy; Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | - Doris H Moreno
- Section of Psychiatric Epidemiology, and Mood Disorders Unit, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Gustavo Turecki
- Research and Academic Affairs, Department of Psychiatry, McGill University, Montréal, QC, Canada; McGill Group for Suicide Studies, Montréal, QC, Canada; Depressive Disorders Program, Douglas Institute, Montréal, QC, Canada; Departments of Psychiatry, Human Genetics, and Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Catherine Reis
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kyooseob Ha
- Mood Disorders Clinic and Affective Neuroscience Laboratory, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Korea Association for Suicide Prevention, Seoul, Republic of Korea
| | - Abraham Weizman
- Laboratory of Biological Psychiatry, The Felsenstein Medical Research Center, Petah Tikva, Israel; Research Unit, Geha Mental Health Center, Petah Tikva, Israel; Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Annette Beautrais
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Yuan-Hwa Chou
- Section of Psychosomatic Medicine, Department of Psychiatry, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Nancy Diazgranados
- Laboratory of Clinical and Translational Studies, National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Carlos A Zarate
- Experimental Therapeutics & Pathophysiology Branch, Division Intramural Research Programs, National Institute of Mental Health, Bethesda, MD, USA
| | - Lakshmi Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Olié E, Seyller M, Beziat S, Loftus J, Bellivier F, Bougerol T, Belzeaux R, Azorin JM, Gard S, Kahn JP, Passerieux C, Leboyer M, Etain B, Henry C, Courtet P. Clinical and neuropsychological characteristics of euthymic bipolar patients having a history of severe suicide attempt. Acta Psychiatr Scand 2015; 131:129-38. [PMID: 25131519 DOI: 10.1111/acps.12326] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Identifying bipolar patients at high-suicide risk is a major health issue. To improve their identification, we compared dimensional and neuropsychological profile of bipolar patients with or without history of suicide attempt, taking into account suicidal severity (i.e. admission to intensive ward). METHOD A total of 343 adult euthymic bipolar out-patients recruited in the French FondaMental Advanced Centres of Expertise for Bipolar Disorder were divided into three subgroups: 214 patients without history of suicide attempt, 88 patients with past history of non-severe suicide attempt and 41 patients with past history of severe suicide attempt. General intellectual functioning, speed of information processing, verbal learning and memory, verbal fluency and executive functioning were assessed. RESULTS Severe suicide attempters had lower affective intensity and lability than non-severe attempters. Severe suicide attempters outperformed non-severe attempters for verbal learning and non-attempters for Stroop word reading part after adjustment for study centre, age, gender, educational level, antipsychotics use, depression score, anxious and addictive comorbidities. CONCLUSION Neuropsychological tasks commonly used to assess bipolar patients do not seem accurate to identify suicide attempters in euthymic patients. In the future, decision-making and emotional recognition tasks should be assessed. Moreover, clinical and neuropsychological profiles should be considered together to better define suicidal risk.
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Affiliation(s)
- E Olié
- Department of Emergency Psychiatry, CHRU, Montpellier, France; INSERM U1061, Montpellier, France; Fondamental Foundation, Foundation of Scientific Cooperation, France
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Schaffer A, Sinyor M, Reis C, Goldstein BI, Levitt AJ. Suicide in bipolar disorder: characteristics and subgroups. Bipolar Disord 2014; 16:732-40. [PMID: 24890795 DOI: 10.1111/bdi.12219] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 11/12/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The development of more sophisticated models for understanding suicide among people with bipolar disorder (BD) requires diagnosis-specific data. The present study aimed to elucidate differences between people who die by suicide with and without BD, and to identify subgroups within those with BD. METHODS Data on all suicide deaths in the city of Toronto from 1998 to 2010 were extracted from the Office of the Chief Coroner of Ontario, including demographics, clinical variables, recent stressors, and details of the suicide. Comparisons of person- and suicide-specific variables between suicide deaths among those with BD (n = 170) and those without (n = 2,716) were conducted, and a cluster analysis was performed among the BD suicide group only. RESULTS Those in the BD suicide group were more likely than those in the non-BD suicide group to be female [odds ratio (OR) = 1.75, 95% confidence interval (CI): 1.27-2.42; p = 0.001], to have made a past suicide attempt (OR = 2.01, 95% CI: 1.45-2.80; p < 0.0001), and to have had recent contact with psychiatric or emergency services (OR = 1.59, 95% CI: 1.00-2.52; p = 0.049). Five clusters were identified within the BD group, with differences between clusters in age; sex; marital status; living circumstances; past suicide attempts; substance abuse; interpersonal, employment/financial, and legal/police stressors; and rates of death by fall/jump or self-poisoning. CONCLUSIONS The present findings identified differences between BD and non-BD suicide groups, providing support to the utilization of an illness-specific approach to better understanding suicide in BD. Subgroups of BD suicide deaths, if replicated, should also be incorporated into the design and analysis of future studies of suicide in BD.
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Affiliation(s)
- Ayal Schaffer
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Cyprien F, Guillaume S, Jaussent I, Lopez-Castroman J, Mercier G, Olie E, Courtet P. Impact of axis-I comorbidity and suicidal behavior disorders on sensitivity and specificity of the Mood Disorder Questionnaire in complex depressed inpatients. Compr Psychiatry 2014; 55:876-82. [PMID: 24625765 DOI: 10.1016/j.comppsych.2014.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE This study assessed the psychometric performance of the Mood Disorder Questionnaire (MDQ) and its modified MDQ7 version, to screen for bipolar disorders (BD) in depressive inpatients according to depression severity, number of current axis I psychiatric comorbidities and suicidal behavior disorders. METHODS Depressed adult inpatients (n=195) were consecutively enrolled. Psychiatric diagnoses were made using the standardized DSM-IV-TR structured interview MINI 5.0.0 and medical case notes. Depression severity was assessed with the Beck Depression Inventory and the Hamilton Depression Scale. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each MDQ version were evaluated in the whole sample and according to depression severity, current axis I psychiatric comorbidities and suicidal behavior. RESULTS The occurrence and the number of axis I disorders affected performance of both versions. Among depressed patients with two or more comorbidities, PPV and NPV of the MDQ were 65% and 80%, respectively, and they were respectively 56.2% and 87.9% with MDQ7. Current suicidal behavior disorders also dramatically reduced the PPV of MDQ (from 81.2% to 63.3%) and MDQ7 (from 72.2% to 52.6%) but the NPV remained above 80%. The performance of both versions of the MDQ tended to improve with the severity of depression. CONCLUSION The MDQ is not a suitable screening instrument to diagnose BD in subjects with a complex major depressive episode and/or a current history of suicidal behavior. Nevertheless MDQ particularly in its modified version may be useful for ruling out the presence of BD among these complex patients.
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Affiliation(s)
- Fabienne Cyprien
- Psychiatric Department, CHU Nîmes, Hopital Carémeau, Nîmes, France; Inserm U1061 Montpellier, France; University of Montpellier 1, Montpellier, France
| | - Sébastien Guillaume
- Inserm U1061 Montpellier, France; Psychiatric Emergency and Post Emergency Department, CHU Montpellier, Hôpital Lapeyronie, Pole Urgence, Montpellier, France; University of Montpellier 1, Montpellier, France.
| | - Isabelle Jaussent
- Inserm U1061 Montpellier, France; University of Montpellier 1, Montpellier, France
| | - Jorge Lopez-Castroman
- Inserm U1061 Montpellier, France; Psychiatric Emergency and Post Emergency Department, CHU Montpellier, Hôpital Lapeyronie, Pole Urgence, Montpellier, France; University of Montpellier 1, Montpellier, France; Department of Psychiatry, IIS-Fundacion Jimenez Diaz, CIBERSAM, Madrid, Spain
| | - Grégoire Mercier
- CHU Montpellier, Information Medical Department, Montpellier, France
| | - Emilie Olie
- Inserm U1061 Montpellier, France; Psychiatric Emergency and Post Emergency Department, CHU Montpellier, Hôpital Lapeyronie, Pole Urgence, Montpellier, France; University of Montpellier 1, Montpellier, France
| | - Philippe Courtet
- Inserm U1061 Montpellier, France; Psychiatric Emergency and Post Emergency Department, CHU Montpellier, Hôpital Lapeyronie, Pole Urgence, Montpellier, France; University of Montpellier 1, Montpellier, France
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Jiménez E, Arias B, Mitjans M, Goikolea JM, Roda E, Sáiz PA, García-Portilla MP, Burón P, Bobes J, Oquendo MA, Vieta E, Benabarre A. Genetic variability at IMPA2, INPP1 and GSK3β increases the risk of suicidal behavior in bipolar patients. Eur Neuropsychopharmacol 2013; 23:1452-62. [PMID: 23453640 DOI: 10.1016/j.euroneuro.2013.01.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 11/20/2012] [Accepted: 01/27/2013] [Indexed: 11/16/2022]
Abstract
Bipolar patients (BP) are at high risk of suicide. Causal factors underlying suicidal behavior are still unclear. However, it has been shown that lithium has antisuicidal properties. Genes involved in its putative mechanism of action such as the phosphoinositol and the Wnt/β-catenine pathways could be considered candidates for suicidal behavior (SB). Our aim was to investigate the association of the IMPA1 and 2, INPP1, GSK3α and β genes with suicidal behavior in BP. 199 BP were recruited. Polymorphisms at the IMPA1 (rs915, rs1058401 and rs2268432) and IMPA2 (rs66938, rs1020294, rs1250171 and rs630110), INPP1 (rs3791809, rs4853694 and 909270), GSK3α (rs3745233) and GSK3β (rs334558, rs1732170 and rs11921360) genes were genotyped. All patients were grouped and compared according to the presence or not of history of SB (defined as the presence of at least one previous suicidal attempt). Single SNP analyses showed that suicide attempters had higher frequencies of AA genotype of the rs669838-IMPA2 and GG genotype of the rs4853694-INPP1gene compared to non-attempters. Results also revealed that T-allele carriers of the rs1732170-GSK3β gene and A-allele carriers of the rs11921360-GSK3β gene had a higher risk for attempting suicide. Haplotype analysis showed that attempters had lower frequencies of A:A haplotype (rs4853694:rs909270) at the INPP1 gene. Higher frequencies of the C:A haplotype and lower frequencies of the A:C haplotype at the GSK-3β gene (rs1732170:rs11921360) were also found to be associated to SB in BP. Therefore, our results suggest that genetic variability at IMPA2, INPP1 and GSK3β genes is associated with the emergence of SB in BP.
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Affiliation(s)
- E Jiménez
- Bipolar Disorder Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Richard-Devantoy S, Guillaume S, Olié E, Courtet P, Jollant F. Altered explicit recognition of facial disgust associated with predisposition to suicidal behavior but not depression. J Affect Disord 2013; 150:590-3. [PMID: 23489393 DOI: 10.1016/j.jad.2013.01.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 01/30/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Suicidal acts result from a complex interplay between vulnerability factors, such as reduced social and cognitive abilities, social stressors. To our knowledge nothing is known about the explicit recognition of others' facial emotions, a major component of social interactions, in patients at long-term risk for suicide. METHODS Thirty-five non-depressed patients with a history of a serious suicide attempt and mood disorders were compared with 31 patients with a history of mood disorders but no personal history of suicidal acts, and with 37 healthy controls with no personal history of mood disorders or suicide attempts. The explicit recognition of six facial emotions (anger, disgust, fear, sadness, happiness, and neutral) was assessed. RESULTS Suicide attempters made significantly more errors in the explicit recognition of disgust, relative to the other groups, with no differences between the control groups or for the other emotions examined. Semantic verbal fluency and verbal working memory performances were also reduced in suicide attempters relative to the other two groups but could not explain the facial recognition deficits. LIMITATIONS Our results need replication with a larger sample size. Most patients were medicated. CONCLUSIONS Explicit recognition of disgust appears to be specifically altered in relation to vulnerability to suicide but not to depression. Reduced ability to recognize some social emotions may impair the patient's capacity to adequately interact with his own social environment, potentially increasing the risk of interpersonal conflict, negative emotions and suicidal crisis. Improving cognitive and social skills may be a target for future individual suicide prevention.
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Affiliation(s)
- Stéphane Richard-Devantoy
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
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14
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Angst J, Hengartner MP, Gamma A, von Zerssen D, Angst F. Mortality of 403 patients with mood disorders 48 to 52 years after their psychiatric hospitalisation. Eur Arch Psychiatry Clin Neurosci 2013; 263:425-34. [PMID: 23124773 DOI: 10.1007/s00406-012-0380-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 10/24/2012] [Indexed: 11/28/2022]
Abstract
The purpose is to analyse differences in mortality among patients with major depressive disorders (MDD), bipolar-II (BP-II), bipolar-I (BP-I) disorders and mania with or without minor depressive disorders and to identify risk factors of mortality. The sample represents all admissions for depression or mania over 5 years (1959-1963) to the Psychiatric Hospital of Zurich University, serving a large area. 403 patients were included and followed up every 5 years until 1985; thereafter, mortality data were collected repeatedly until 2009 when 352 (87 %) patients had died. Standardised mortality ratios (SMRs) were computed and survival analyses applied. With the exception of BP-II disorder, the three other diagnostic groups showed elevated SMRs. The group with mania had the highest SMR for cardiovascular deaths and the group with MDD the highest for deaths by suicide. Mortality was also high among patients with late-onset MDD. Across the diagnostic spectrum, we found differences in risk factors for mortality, such as a family history of suicides and personality type: more anxious patients with MDD lived longer, and among patients with BP disorders, more tense (aggressive) types had shorter lives. Long-term medication had a protective effect against mortality in patients with MDD during years 1-9 and in patients with BP disorders during years 1-19 after admission. We found marked differences in causes of death and risk factors between subgroups of mood disorders. For the purpose of further research, it would be recommendable to distinguish pure mania from bipolar disorders.
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Affiliation(s)
- Jules Angst
- Zurich University Psychiatric Hospital, Zurich, Switzerland.
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15
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Serretti A, Chiesa A, Calati R, Linotte S, Sentissi O, Papageorgiou K, Kasper S, Zohar J, De Ronchi D, Mendlewicz J, Amital D, Montgomery S, Souery D. Influence of family history of major depression, bipolar disorder, and suicide on clinical features in patients with major depression and bipolar disorder. Eur Arch Psychiatry Clin Neurosci 2013; 263:93-103. [PMID: 22569753 DOI: 10.1007/s00406-012-0322-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
Abstract
The extent to which a family history of mood disorders and suicide could impact on clinical features of patients suffering from major depression (MD) and bipolar disorder (BD) has received relatively little attention so far. The aim of the present work is, therefore, to assess the clinical implications of the presence of at least one first- and/or second-degree relative with a history of MD, BD and suicide in a large sample of patients with MD or BD. One thousand one hundred and fifty-seven subjects with MD and 686 subjects with BD were recruited within the context of two large projects. The impact of a family history of MD, BD, and suicide-considered both separately and together-on clinical and socio-demographic variables was investigated. A family history of MD, BD, and suicide was more common in BD patients than in MD patients. A positive family history of mood disorders and/or suicide as well as a positive family history of MD and BD separately considered, but not a positive history of suicide alone, were significantly associated with a comorbidity with several anxiety disorders and inversely associated with age of onset. The clinical implications as well as the limitations of our findings are discussed.
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Affiliation(s)
- Alessandro Serretti
- Institute of Psychiatry, University of Bologna, Viale Carlo Pepoli 5, 40123, Bologna, Italy
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16
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Aguiar JCA, Gomes EPP, Fonseca-Silva T, Velloso NA, Vieira LT, Fernandes MF, Santos SHS, Neto JFR, De-Paula AMB, Guimarães ALS. Fluoxetine reduces periodontal disease progression in a conditioned fear stress model in rats. J Periodontal Res 2013; 48:632-7. [DOI: 10.1111/jre.12049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2012] [Indexed: 11/29/2022]
Affiliation(s)
- J. C. A. Aguiar
- Department of Dentistry; Universidade Estadual de Montes Claros; Montes Claros Brazil
- School of Psychology; Faculdades Integradas Pitágoras; Montes Claros Brazil
| | - E. P. P. Gomes
- Department of Dentistry; Universidade Estadual de Montes Claros; Montes Claros Brazil
| | - T. Fonseca-Silva
- Department of Dentistry; Universidade Estadual de Montes Claros; Montes Claros Brazil
| | - N. A. Velloso
- School of Pharmacy; Faculdades Santo Agostinho; Montes Claros Brazil
| | - L. T. Vieira
- Department of Dentistry; Universidade Estadual de Montes Claros; Montes Claros Brazil
| | - M. F. Fernandes
- Department of Mathematics; Universidade Estadual de Montes Claros; Montes Claros Brazil
| | - S. H. S. Santos
- Department of Medicine; Universidade Estadual de Montes Claros; Montes Claros Brazil
- Department of Pharmacology; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | - J. F. R. Neto
- Department of Medicine; Universidade Estadual de Montes Claros; Montes Claros Brazil
| | - A. M. B. De-Paula
- Department of Dentistry; Universidade Estadual de Montes Claros; Montes Claros Brazil
| | - A. L. S. Guimarães
- Department of Dentistry; Universidade Estadual de Montes Claros; Montes Claros Brazil
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17
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Drancourt N, Etain B, Lajnef M, Henry C, Raust A, Cochet B, Mathieu F, Gard S, Mbailara K, Zanouy L, Kahn JP, Cohen RF, Wajsbrot-Elgrabli O, Leboyer M, Scott J, Bellivier F. Duration of untreated bipolar disorder: missed opportunities on the long road to optimal treatment. Acta Psychiatr Scand 2013; 127:136-44. [PMID: 22901015 DOI: 10.1111/j.1600-0447.2012.01917.x] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Duration of untreated illness represents a potentially modifiable component of any diagnosis-treatment pathway. In bipolar disorder (BD), this concept has rarely been systematically defined or not been applied to large clinically representative samples. METHOD In a well-characterized sample of 501 patients with BD, we estimated the duration of untreated bipolar disorder (DUB: the interval between the first major mood episode and first treatment with a mood stabilizer). Associations between DUB and clinical onset and the temporal sequence of key clinical milestones were examined. RESULTS The mean DUB was 9.6 years (SD 9.7; median 6). The median DUB for those with a hypomanic onset (14.5 years) exceeded that for depressive (13 years) and manic onset (8 years). Early onset BD cases have the longest DUB (P < 0.0001). An extended DUB was associated with more mood episodes (P < 0.0001), more suicidal behaviour (P = 0.0003) and a trend towards greater lifetime mood instability (e.g. rapid cycling, possible antidepressant-induced mania). CONCLUSION Duration of untreated bipolar disorder (DUB) will only be significantly reduced by more aggressive case finding strategies. Reliable diagnosis (especially for BD-II) and/or instigation of recommended treatments is currently delayed by insufficient awareness of the early, polymorphous presentations of BD, lack of systematic screening and/or failure to follow established guidelines.
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Affiliation(s)
- N Drancourt
- AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France
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18
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Gonda X, Pompili M, Serafini G, Montebovi F, Campi S, Dome P, Duleba T, Girardi P, Rihmer Z. Suicidal behavior in bipolar disorder: epidemiology, characteristics and major risk factors. J Affect Disord 2012; 143:16-26. [PMID: 22763038 DOI: 10.1016/j.jad.2012.04.041] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 04/19/2012] [Accepted: 04/19/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Suicide is one of the leading causes of death and a major public health problem worldwide, and the majority of suicide attempters and completers suffer from some major affective disorder at the time of their death, which, in the majority of cases is unrecognized, under- or misdiagnosed and untreated. METHODS Based on a systematic literature search, the authors give a detailed and critical overview of established risk factors of suicide in bipolar disorder. RESULTS Among affective disorders, bipolar disorder carries the highest risk of suicide, yet not all bipolar patients commit or even attempt suicide during their illness. While the general suicide risk factors also apply for bipolar disorders, there are several disease-specific risk factors as well which should be taken into account when evaluating suicide risk in case of patients. CONCLUSION It is crucial to identify suicide risk factors in bipolar disorder to be able to differentiate those patients within this already increased-risk illness group who are at especially high risk and therefore to allow for better prediction and prevention of suicidal acts.
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Affiliation(s)
- Xenia Gonda
- Department of Clinical and Theoretical Mental Health, Kútvölgyi Clinical Center, Semmelweis University, Kútvölgyi ut 4., 1125 Budapest, Hungary.
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19
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Chartrand H, Robinson J, Bolton JM. A longitudinal population-based study exploring treatment utilization and suicidal ideation and behavior in major depressive disorder. J Affect Disord 2012; 141:237-45. [PMID: 22703701 DOI: 10.1016/j.jad.2012.03.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 03/12/2012] [Accepted: 03/19/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study aimed to longitudinally examine the relationship between treatment utilization and suicidal behavior among people with major depressive disorder in a nationally representative sample. METHODS Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (Wave 1: N=43,093; Wave 2: N=34,653). Suicidal and non-suicidal individuals at Wave 1 were compared based on subsequent treatment utilization. Suicidal behavior at Wave 2 was compared between people with major depressive disorder who had sought treatment at Wave 1 versus those that had not. RESULTS Individuals with past year major depressive disorder at Wave 1 who attempted suicide were more likely to be hospitalized at follow up compared to non-suicidal people with major depressive disorder [adjusted odds ratio (AOR)=4.46; 95% confidence interval [95% CI]: 2.54-7.85]; however, they were not more likely to seek other forms of treatment. Among those with past year major depressive disorder who sought treatment at baseline, visiting an emergency room (AOR=3.08; 95% CI: 1.61-5.89) and being hospitalized (AOR=2.41; 95% CI: 1.13-5.14), was associated with an increased likelihood of attempting suicide within 3 years even after adjusting for mental disorder comorbidity, depression severity, and previous suicidal behavior. LIMITATIONS Unable to draw conclusions about completed suicide or adequacy of treatment. CONCLUSIONS Suicidal behavior does not lead individuals with major depressive disorder to seek treatment with professionals or use antidepressant medications; instead, they are more likely to use emergency services. These findings suggest that treatment efforts for people with major depressive disorder who are suicidal need improvement.
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Affiliation(s)
- Hayley Chartrand
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
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20
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Affiliation(s)
- P Courtet
- INSERM U106, 1 Département d'Urgence et Post Urgence Psychiatrique, Université Montpellier, CHRU Montpellier, Hôpital Lapeyronie, Montpellier, France.
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21
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Guillaume S, Courtet P, Samalin L. Dépression bipolaire et conduites suicidaires. Encephale 2011; 37 Suppl 3:S169-72. [DOI: 10.1016/s0013-7006(11)70047-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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22
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Parmentier C, Etain B, Yon L, Misson H, Mathieu F, Lajnef M, Cochet B, Raust A, Kahn JP, Wajsbrot-Elgrabli O, Cohen R, Henry C, Leboyer M, Bellivier F. Clinical and dimensional characteristics of euthymic bipolar patients with or without suicidal behavior. Eur Psychiatry 2011; 27:570-6. [PMID: 21978427 DOI: 10.1016/j.eurpsy.2011.05.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 05/13/2011] [Accepted: 05/26/2011] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The clinical and dimensional features associated with suicidal behaviour in bipolar patients during euthymic states are not well characterised. METHODS In a sample of 652 euthymic bipolar patients, we assessed clinical features with the Diagnostic Interview for Genetics Studies (DIGS) and dimensional characteristics with questionnaires measuring impulsivity/hostility and affective lability/intensity. Bipolar patients with and without suicidal behaviour were compared for these clinical and dimensional variables. RESULTS Of the 652 subjects, 42.9% had experienced at least one suicide attempt. Lifetime history of suicidal behaviour was associated with being a woman, a history of head injury, tobacco misuse and indicators of severity of bipolar disorder including early age at onset, high number of depressive episodes, positive history of rapid cycling, alcohol misuse and social phobia. Indirect hostility and irritability were dimensional characteristics associated with suicidal behaviour in bipolar patients, whereas impulsivity and affective lability/intensity were not associated with suicidal behaviour. LIMITATIONS This study had a retrospective design with no replication sample. CONCLUSIONS Bipolar patients with earlier onset, mood instability (large number of depressive episodes, rapid cycling) and/or particular addictive and anxiety comorbid disorders might be at high risk of suicidal behaviour. In addition, hostility dimensions (indirect hostility and irritability), may be trait components associated with suicidal behaviour in euthymic bipolar patients.
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Affiliation(s)
- C Parmentier
- AP-HP, groupe Henri-Mondor-Albert-Chenevier, pôle de psychiatrie, 94000 Créteil, France.
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Guillaume S, Jaussent I, Olié E, Genty C, Bringer J, Courtet P, Schmidt U. Characteristics of suicide attempts in anorexia and bulimia nervosa: a case-control study. PLoS One 2011; 6:e23578. [PMID: 21858173 PMCID: PMC3155572 DOI: 10.1371/journal.pone.0023578] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 07/21/2011] [Indexed: 01/21/2023] Open
Abstract
Objective Compared to other eating disorders, anorexia nervosa (AN) has the highest rates of completed suicide whereas suicide attempt rates are similar or lower than in bulimia nervosa (BN). Attempted suicide is a key predictor of suicide, thus this mismatch is intriguing. We sought to explore whether the clinical characteristics of suicidal acts differ between suicide attempters with AN, BN or without an eating disorders (ED). Method Case-control study in a cohort of suicide attempters (n = 1563). Forty-four patients with AN and 71 with BN were compared with 235 non-ED attempters matched for sex, age and education, using interview measures of suicidal intent and severity. Results AN patients were more likely to have made a serious attempt (OR = 3.4, 95% CI 1.4–7.9), with a higher expectation of dying (OR = 3.7,95% CI 1.1–13.5), and an increased risk of severity (OR = 3.4,95% CI 1.2–9.6). BN patients did not differ from the control group. Clinical markers of the severity of ED were associated with the seriousness of the attempt. Conclusion There are distinct features of suicide attempts in AN. This may explain the higher suicide rates in AN. Higher completed suicide rates in AN may be partially explained by AN patients' higher desire to die and their more severe and lethal attempts.
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Hantouche E, Angst J, Azorin JM. Explained factors of suicide attempts in major depression. J Affect Disord 2010; 127:305-8. [PMID: 20554011 DOI: 10.1016/j.jad.2010.04.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Revised: 04/29/2010] [Accepted: 04/29/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study is to identify risk factors for suicide attempts including bipolarity. METHOD The paper presents the most recent data on suicide attempts and depression with or without hypomanic features from three French "Bipolact", studies including 2249 patients with recurrent or resistant depression. Hypomania and BP-II disorder were defined by a score of 10 or more on the Hypomania Checklist-20. Attempters and non-attempters were compared, and multivariate logistic regression analyses were performed on all the significant variables obtained in univariate tests. RESULTS Rates of suicide attempts and of a family history of suicide were higher in BP-II disorder. Suicide attempts were best explained by a family history of suicide and mood disorders, recurrence of depression, the "irritable-risk-taking" dimension of hypomania, substance abuse, and need of psychiatric treatment. LIMITATIONS The study does not deal with DSM-IV BP-II disorder. CONCLUSION Clinicians need to be familiarized with these risk factors.
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Affiliation(s)
- Elie Hantouche
- Anxiety and Mood Center, CTAH, 117 rue de Rennes, Paris, France.
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25
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Jeon HJ, Lee JY, Lee YM, Hong JP, Won SH, Cho SJ, Kim JY, Chang SM, Lee HW, Cho MJ. Unplanned versus planned suicide attempters, precipitants, methods, and an association with mental disorders in a Korea-based community sample. J Affect Disord 2010; 127:274-80. [PMID: 20591495 DOI: 10.1016/j.jad.2010.05.027] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 05/30/2010] [Accepted: 05/30/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Studies have consistently reported that a considerable proportion of suicidal attempts are unplanned. We have performed the first direct comparison between planned and unplanned attempts including associated methods and precipitants. METHOD A total of 6510 adults, who had been randomly selected through a one-person-per-household method, completed interviews (response rate 81.7%). All were interviewed using the K-CIDI and a questionnaire for suicide. RESULTS Two hundred and eight subjects reported a suicide attempt in their lifetime, one-third of which had been unplanned. These individuals exhibited a lower level of education; however, no significant differences were found with regard to age, gender, marital and economic status. Further, 84.0% of unplanned attempters experienced previous suicidal ideation, experiencing their first attempt 1.9 years before ideation. Additionally, 94.4% of unplanned attempters had precipitants for attempts such as familial conflict and it was also found that methods such as the use of chemical agents or falling were three times more common in unplanned than planned attempters. With respect to unplanned attempters, they exhibited a significant association with alcohol use disorder, major depressive disorder, posttraumatic stress disorder, and bipolar disorder. In particular, bipolar disorder was found to be 3.5 times higher in these individuals. CONCLUSIONS Results have revealed that unplanned suicide attempters experience suicidal ideation and precipitants prior to their attempt. Further, attempts were associated with affective and alcohol use disorders. Therefore, in order to reduce the number of suicidal attempts, it may be useful to evaluate suicidal ideation concurrent to the treatment of existing mental disorders.
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Affiliation(s)
- Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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