Suicidal behaviour in a French Cohort of major depressive patients: characteristics of attempters and nonattempters

The relationship between a comprehensive index of prosperity and suicide rates in former Soviet countries, including a comparison with European and Asian countries: Discussion from a new perspective

Investigations of suicide in countries of the former Soviet Union, which broke into 15 different countries in the early 1990s, require examinations of a combination of economic, social, and health factors. It is important to address these factors individually and to examine the various composite indicators for each. Moreover, it would be worthwhile to explore the potential applicability of a comprehensive worldwide index. We analyzed data from nine of the former Soviet countries for which both the annual suicide rate and the Global Competitiveness Index (GCI) were available for the years 2006-2017. We determined the precise relationships between the suicide rate and the GCI during this period in these nine countries as well as in nine countries with high suicide rates in Europe and Asia. The results indicated the following: (i) In six of the nine former Soviet countries with complete data, the suicide rate showed a relationship with the GCI. Notably, this relationship was inverse in all but one country. (ii) Among the nine European and Asian countries with high suicide rates, three exhibited a correlation between the suicide rate and the GCI. Measures to prevent suicide should be devised especially in countries of the former Soviet Union through collaboration among multiple fields and organizations, as necessary, with particular attention paid to countries with worse or worsening GCI values.

Interaction between HTR2A rs3125 and negative life events in suicide attempts among patients with major depressive disorder: a cross-sectional study

BACKGROUND

Both genetic and environmental factors play crucial roles in the development of major depressive disorder (MDD) and suicide attempts (SA). However, the interaction between both items remains unknown. This study aims to explore the interactions between the genetic variants of the serotonin 2 A receptor (HTR2A) and the nitric oxide synthase 1 (NOS1) and environmental factors in patients who experience MDD and SA.

METHODS

A total of 334 patients with MDD and a history of SA (MDD-SA) were recruited alongside 518 patients with MDD with no history of SA (MDD-NSA), and 716 healthy controls (HC). The demographic data and clinical characteristics were collected. Sequenom mass spectrometry was used to detect eight tag-single nucleotide polymorphisms (tagSNPs) in HTR2A (rs1328683, rs17068986, and rs3125) and NOS1 (rs1123425, rs2682826, rs3741476, rs527590, and rs7959232). Generalized multifactor dimensionality reduction (GMDR) was used to analyze the gene-environment interactions.

RESULTS

Four tagSNPs (rs17068986, rs3125, rs527590, and rs7959232) exhibited significant differences between the three groups. However, these differences were not significant between the MDD-SA and MDD-NSA groups after Bonferroni correction. A logistic regression analysis revealed that negative life events (OR = 1.495, 95%CI: 1.071-2.087, P = 0.018), self-guilt (OR = 2.263, 95%CI: 1.515-3.379, P < 0.001), and negative cognition (OR = 2.252, 95%CI: 1.264-4.013, P = 0.006) were all independently associated with SA in patients with MDD. Furthermore, GMDR analysis indicated a significant interaction between HTR2A rs3125 and negative life events. Negative life events in conjunction with the HTR2A rs3125 CG + GG genotype were associated with a higher SA risk in patients with MDD when compared to the absence of negative life events in conjunction with the CC genotype (OR = 2.547, 95% CI: 1.264-5.131, P = 0.009).

CONCLUSION

Several risk factors and a potential interaction between HTR2A rs3125 and negative life events were identified in patients with SA and MDD. The observed interaction likely modulates the risk of MDD and SA, shedding light on the pathogenesis of SA in patients with MDD.

Sex difference in association between suicide attempts and lipid profile in first-episode and drug naive patients with major depressive disorder

BACKGROUND

The relationship between suicide attempts and lipid profiles in patients with major depressive disorder (MDD) remains uncertain. The purpose of this study was to investigate sex differences in the relationship between suicide attempts and plasma lipid profiles in a large sample of first-episode and drug naive (FEDN) MDD patients.

METHODS

We recruited 1718 FEDN MDD patients and gathered demographic, clinical, and blood lipid data. The Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale and the Positive and Negative Syndrome Scale were used to assess the symptoms of patients.

RESULTS

There was no significant difference in the prevalence of suicide attempts between male and female MDD patients. The suicide attempt group had higher levels of depression, anxiety, psychotic symptoms, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C), but lower levels of high-density lipoprotein cholesterol (HDL-C) levels than the non-suicide attempt group. Binary logistic regression showed that TC levels were significantly correlated with suicidal attempts in both male and female patients. Correlation analysis revealed that the levels of TC, HDL-C and LDL-C were significantly associated with the number of suicide attempts in both male and female patients. Further multiple linear regression revealed that TC levels were significantly associated with the number of suicide attempts in male patients only.

CONCLUSIONS

Lipid biomarkers, particularly high TC levels, are associated with suicide attempts in both male and female MDD patients. However, there is gender difference in association between lipid biomarkers, especially TC levels, and the number of suicide attempts in MDD patients.

Sex differences in prevalence and clinical correlates of suicide attempts in first-episode and drug-naïve patients with anxious depression in a Chinese Han population: A large-scale cross-sectional study

BACKGROUNDS

Anxious depression (AD) has been extensively studied. However, fewer studies have examined sex differences in the prevalence of suicide attempts among AD patients. This study aimed to explore sex differences in suicide attempts and risk factors in patients with AD.

METHODS

1380 first episode drug-naïve patients with AD were recruited. Sociodemographic and clinical characteristics were measured using a self-administered demographic questionnaire. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Inventory (HAMA), and positive subscale of the Positive and Negative Syndrome Scale (PANSS) were used to assess patients' clinical symptoms. We also measured the patient's blood glucose, lipids, and thyroid axis hormone levels.

RESULTS

There were no sex differences in the prevalence of suicide attempts in patients with FEDN anxious depression. In addition, binary logistic regression analysis showed that HAMA score, TSH levels, and TPOAb levels significantly predicted suicide attempts in both male and female patients with AD, while HAMD score significantly predicted suicide attempts in female patients with AD only.

CONCLUSIONS

The severity of anxiety and higher levels of TSH and TPOAb were associated with an increased risk for suicide attempts in both male and female patients with AD, whereas the severity of depression was only associated with suicide attempts in females.

Association between body mass index and suicide attempts in Chinese patients of a hospital in Shanxi district with first-episode drug-naïve major depressive disorder

OBJECTIVE

In patients with major depressive disorder (MDD), the relationship between body mass index (BMI) and risk of suicide attempts (SA) remains unclear, and findings are controversial. The aim of this study was to investigate the relationship between BMI and SA in a Chinese population with first-episode drug-naïve (FEDN) MDD.

METHODS

A total of 1718 patients with FEDN MDD were enrolled in this cross-sectional study. Their socio-demographic characteristics as well as anthropometric data were collected. The 17-item Hamilton Rating Scale (HAMD-17) and Hamilton Anxiety Scale (HAMA) were used to assess the severity of depression and anxiety symptoms in all participants. Thyroid hormones, lipid profile, and fasting blood glucose (FBG) were measured. A history of suicide attempts was verified based on medical records and interviews with patients and their family members. Multiple logistic regression analysis was used to estimate the association between BMI and the risk of SA. Threshold effects were examined by a two-piecewise logistic regression model.

RESULTS

Multiple logistic regression analysis showed that BMI was independently and negatively correlated with SA (OR = 0.91, 95%CI: 0.85 to 0.98, P = 0.01) in patients with FEDN MDD after adjusting for covariates. Smoothing plots also revealed a non-linear (L-shaped) relationship between BMI and SA, and a two-piecewise logistic regression model was used to calculate the inflection point of BMI as 22.1 kg/m2. On the left of the inflection point, a negative association between BMI and SA was detected (OR = 0.54, 95%CI: 0.42 to 0.70, P < 0.001), while no significant association was observed on the right side of the inflection point (OR = 1.01, 95%CI: 0.93 to 1.10, P = 0.75).

CONCLUSIONS

Our results suggest that lower BMI is associated with a higher risk of recent SA in Chinese patients with FEDN MDD, especially in those with BMI below 22.1 kg/m2.

Sex-differential association of suicide attempts with thyroid dysfunction in first-episode and drug-naïve young major depressive disorder patients with comorbid anxiety

This study aimed to explore sex differences in the relationship between thyroid function indicators and suicide attempts in first-episode and drug-naïve young major depressive disorder (MDD) patients with comorbid anxiety (MDA). A total of 917 MDD patients (aged 18-35 years) were recruited. The Hamilton depression rating scale (HAMD-17), Hamilton anxiety rating scale (HAMA), positive and negative syndrome scale (PANSS) positive subscale and clinical global impression of severity scale (CGI-S) were used. 467 patients were classified as MDA. The prevalence of suicide attempts was 31.3% in MDA patients, which was significantly higher than that (7.3%) in MDD patients without anxiety. Compared with MDA patients without suicide attempts, MDA patients with suicide attempts were older, had a later age of onset, higher HAMD-17, HAMA, and PANSS positive symptom subscale scores, as well as higher TSH, TgAb and TPOAb levels. For male patients, TSH and TPOAb levels were independently associated with suicide attempts. For female patients, HAMA, PANSS positive symptom scores, CGI-S score and TPOAb levels were independently associated with suicide attempts. Our results suggest that the indicators of thyroid function which can predict suicide attempts in male and female MDA patients have sex differences.

Association between triglyceride glucose index and suicide attempts in patients with first-episode drug-naïve major depressive disorder

Objective

Triglyceride glucose (TyG) index has been suggested as an alternative indicator of insulin resistance (IR); however, the association between TyG index and suicide attempts (SA) in major depressive disorder (MDD) is unclear. The aim of this study was to investigate the relationship between TyG index and SA in Chinese patients with first-episode drug-naïve (FEDN) MDD.

Methods

This cross-sectional study enrolled 1,718 patients with FEDN MDD aged 34.9 ± 12.4 years from the First Hospital of Shanxi Medical University (Taiyuan, Shanxi Province, China) from September 2016 to December 2018. Multivariable binary logistic regression analysis was used to estimate the association between TyG index and the risk of SA. A two-piecewise linear regression model was used to investigate the threshold effects if non-linearity associations existed. Interaction and stratified analyses were performed based on sex, education, marital status, comorbid anxiety, and psychotic symptoms.

Results

Multivariable logistic regression analysis revealed that TyG index was positively associated with the risk of SA after adjusting for confounders (OR = 1.35, 95% CI: 1.04-1.75, p = 0.03). Smoothing plots also showed a nonlinear relationship between TyG index and SA, with the inflection point of TyG index being 9.29. On the right of the inflection point, a positive association between TyG index and SA was detected (OR = 3.47, 95% CI: 1.81 to 6.66, p < 0.001), while no significant association was observed on the left side of the inflection point (OR = 1.14, 95% CI: 0.79 to 1.66, p = 0.476).

Conclusion

The relationship between TyG index and SA risk was non-linear and exhibited a threshold effect in Chinese patients with FEDN MDD. When TyG index was greater than 9.29, they showed a significant positive correlation.

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.

Clinical characteristics and prescriptions associated with a 2-year course of rapid cycling and euthymia in bipolar disorder: a multicenter treatment survey for bipolar disorder in psychiatric clinics

Objective

In patients with bipolar disorder (BD), rapid cycling (RC) presents a risk for a more severe illness, while euthymia (EUT) has a better prognosis. This study focused on the progression of RC and EUT, which are contrasting phenomenology, and aimed to clarify the influence of patient backgrounds and prescription patterns on these different progressions, using a large sample from the first and second iterations of a multicenter treatment survey for BD in psychiatric clinics (MUSUBI).

Methods

In the cross-sectional study (MUSUBI), a questionnaire based on a retrospective medical record survey of consecutive BD cases (N = 2,650) was distributed. The first survey was conducted in 2016, and the second one in 2017. The questionnaire collected information on patient backgrounds, current episodes, and clinical and prescribing characteristics.

Results

In the first survey, 10.6% of the participants had RC and 3.6% had RC for two consecutive years, which correlated with BP I (Bipolar disorder type I), suicidal ideation, duration of illness, and the use of lithium carbonate and antipsychotic medications. Possible risk factors for switching to RC were comorbid developmental disorders and the prescription of anxiolytics and sleep medication. Moreover, 16.4% of the participants presented EUT in the first survey, and 11.0% presented EUT for two consecutive years. Possible factors for achieving EUT included older age; employment; fewer psychotic symptoms and comorbid personality disorders; fewer antidepressants, antipsychotics, and anxiolytics, and more lithium prescriptions.

Conclusion

RC and EUT generally exhibit conflicting characteristics, and the conflicting social backgrounds and factors contributing to their outcomes were distinctive. Understanding these clinical characteristics may be helpful in clinical practice for management of patients with BD.

Metabolic parameters and thyroid hormones in relation to suicide attempts in patients with first-episode and drug-naive major depressive disorder with comorbid glucose disturbances: a large cross-sectional study

The factors associated with suicide attempts in major depressive disorder (MDD) patients with comorbid glucose disturbances remain unclear. To the best of our knowledge, this is the first study with a large sample size to examine risk factors of suicide attempts in first-episode drug-naïve (FEDN) MDD patients with comorbid glucose disturbances, including clinically relevant factors, 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 clinical symptoms of patients. Fasting blood glucose, metabolic parameters, and thyroid hormone levels were measured. After controlling for HAMA and HAMD scores, the suicide attempt rate was 1.88 times higher in MDD patients with glucose disturbances than in MDD patients without glucose disturbances. Compared to non-suicide attempters, suicide attempters among the MDD patients with glucose disturbances had higher scores on HAMD and HAMA, PANSS positive symptoms, as well as higher levels of systolic and diastolic blood pressure, TC, LDL-C, thyroid stimulating hormone (TSH), TgAb, and thyroid peroxidases antibody (TPOAb). The combination of positive symptom score, HDL-C, systolic blood pressure, and marital status distinguished suicide attempters from non-suicide attempters. In addition, HAMA score, HAMD score, and TPOAb were associated with the number of suicide attempts in MDD patients with comorbid glucose disturbances. Our results suggest a high incidence of suicide attempts in MDD patients with comorbid glucose disturbances. Several clinically relevant factors, metabolic parameters, and thyroid hormone function have an impact on suicide attempts in MDD patients with comorbid glucose disturbances.

The Impact of Affective Temperaments on Suicidal Ideation and Behaviors: Results from an Observational Multicentric Study on Patients with Mood Disorders

Suicide ideation and behaviors are major health issues in the field of mental health. Several psychological and psychosocial factors have been taken into account as possible predictors of suicidality. Only recently affective temperaments have been considered as possible factors linked to suicide. This study aims to investigate the relationship between affective temperaments and suicidality, including the lifetime onset of suicide ideation, lifetime presence of suicide attempts and the total number of lifetime suicide attempts. This is a naturalistic multicentric observational study, involving outpatient units of seven University sites in Italy. Patients were administered with the short version of TEMPS-M and the Columbia Suicide Severity Rating Scale. A total of 653 participants were recruited, with a diagnosis of bipolar (55.7%), unipolar (35.8%) and cyclothymic disorder (8.4%). Regression models showed that the presence of lifetime suicide behaviors was increased in patients presenting trait related impulsivity (p < 0.0001), poor free-interval functioning (p < 0.05), higher number of affective episodes (p < 0.01), higher number of hospitalizations (p < 0.0001), cyclothymic and irritable affective temperaments (p < 0.05 and p < 0.05, respectively). Conversely, the presence of hyperthymic affective disposition reduced the likelihood of having suicidal behaviors (p < 0.01). Lifetime suicidal ideation was associated with trait-related impulsivity (p < 0.001), poor free-interval functioning (p < 0.05), higher number of affective episodes (p < 0.001) and of hospitalizations (p < 0.001). Depressive temperaments increased the likelihood of presenting suicidal ideation (p < 0.05), along with irritable temperaments (p < 0.01), contrary to hyperthymic affective (p < 0.05). Results of the present study confirm that affective disposition has a significant impact on the onset of suicidal ideation and behaviors, and that affective dispositions should be assessed in clinical settings to identify people at risk of suicide. Moreover, a wider clinical evaluation, including different clinical psychopathological dimensions, should be taken into consideration to develop effective preventive interventions.

Eating disorders among middle school students in a Chinese population: Prevalence and associated clinical correlates

INTRODUCTION

Eating disorders are regarded to be associated with many psychological and behavioral problems. Moreover, adolescence has been reported to be the key period for developing eating habits, and eating disorders typically emerge in adolescence and early adulthood. This study aimed to investigate the prevalence of eating disorders and explore the associated factors among adolescents in Hunan province, China METHODS: A total of 1610 middle school students from Hunan province, China, were enrolled in this study. The participants were aged from 11 to 16 years old. The following data were collected: demographic variables, Body Mass Index (BMI), suicidal behaviors, non-suicidal self-injury, depression, anxiety, stress (depression - anxiety - stress scale, DASS-21), childhood trauma (Childhood Trauma Questionnaire, CTQ), symptoms of social anxiety (Social Anxiety Scale-Adolescents, SAS-A), and eating problems (Eating Attitudes Test, EAT-26).

RESULTS

The estimated prevalence of eating disorders was 8.9%. Compared with participants without eating disorders, participants with eating disorders were more likely to be at a younger age, obese and overweight, and have a history of non-suicidal self-injury, suicidal ideation, suicidal plans, suicide attempts, emotional abuse, physical abuse, emotional neglect, and physical neglect; more likely to experience stress, anxiety or depression as well as have high scores of social avoidance and distress related to general social contexts. Anxiety, emotional neglect, physical neglect, obesity, and overweight were still significant in the binary logistic regression model after controlling for confounding factors. Additionally, younger age, emotional abuse, physical abuse, stress, anxiety, depression, social avoidance, and distress related to general social contexts were significantly correlated with the EAT-26 scores in correlation analysis CONCLUSIONS: Eating disorders are quite common among middle school students. Moreover, eating disorders are associated with younger age, non-suicidal self-injury, suicidal ideation, suicide attempts, stress, anxiety, depression, emotional abuse, physical abuse, emotional neglect, physical neglect, social avoidance, and distress related to general social contents and BMI. This study provides a reference for school counselors and clinicians in the prevention and treatment of eating disorders.

Suicide attempt rate and the risk factors in young, first-episode and drug-naïve Chinese Han patients with major depressive disorder

BACKGROUND

In recent years, the rates of suicide among young people have been increasing, and major depressive disorder (MDD) is regarded to be its main cause. Many factors such as thyroid dysfunction and metabolic abnormalities are thought to mediate this process, but the conclusions are inconsistent. This study investigated the rate of suicide attempts and associated risk factors among young, first-episode and drug-naïve Chinese Han patients with MDD.

METHODS

A total of 917 patients with MDD (aged 18 ~ 35 years) were recruited. Demographic and clinical data were collected and thyroid function, fasting blood glucose and lipid profiles were measured. The Hamilton Depression Rating Scale-17 items (HAMD-17), Hamilton Anxiety Rating Scale (HAMA), positive symptom subscale of Positive and Negative Syndrome Scale (PANSS) and clinical global impression of severity scale (CGI-S) were adopted to assess depression, anxiety, psychotic symptoms and disease severity respectively.

RESULTS

The rate of suicide attempts was 19.5% in young MDD patients. There were significant differences in age (p = 0.003), education level (p = 0.001), age of onset (p = 0.004) and disease duration (p = 0.001) between patients with and without suicide attempts. Compared with patients without suicide attempts, patients with suicide attempts had significantly higher scores on the HAMD-17, HAMA, PANSS positive symptom subscale and CGI-S (all p < 0.001). Patients with suicide attempts had significantly higher levels of TSH (p < 0.001), TgAb (p = 0.004), TPOAb (p < 0.001), TG (p = 0.016), TC (p < 0.001), LDL (p < 0.001), and fasting glucose (p < 0.001), but significantly lower levels of HDL (p < 0.001). Logistic regression analysis showed that marital status (OR = 0.515, 95%CI: 0.280-0.950, p = 0.515), disease duration (OR = 1.100, 95%CI: 1.013-1.194, p = 0.024), HAMA score (OR = 1.313, 95%CI: 1.205-1.430, p < 0.001), CGI-S score (OR = 1.875, 95%CI: 1.339-2.624, p < 0.001), levels of FT3(OR = 0.717, 95%CI: 0.536-0.959, p = 0.025), TPOAb (OR = 1.004, 95%CI: 1.002-1.006, p < 0.001), TC (OR = 1.330, 95%CI: 1.011-1.750, p = 0.042) and LDL (OR = 0.736, 95%CI: 0.558-0.971, p = 0.030) were all independently associated with suicide attempts in young MDD patients.

CONCLUSIONS

In China, the rate of suicide attempts in young patients with MDD is quite high and thyroid dysfunction and metabolic abnormalities may be implicated in its pathogenesis.

Shared and specific patterns of dynamic functional connectivity variability of striato-cortical circuitry in unmedicated bipolar and major depressive disorders

BACKGROUND

Accumulating studies have found structural and functional abnormalities of the striatum in bipolar disorder (BD) and major depressive disorder (MDD). However, changes in intrinsic brain functional connectivity dynamics of striato-cortical circuitry have not been investigated in BD and MDD. This study aimed to investigate the shared and specific patterns of dynamic functional connectivity (dFC) variability of striato-cortical circuitry in BD and MDD.

METHODS

Brain resting-state functional magnetic resonance imaging data were acquired from 128 patients with unmedicated BD II (current episode depressed), 140 patients with unmedicated MDD, and 132 healthy controls (HCs). Six pairs of striatum seed regions were selected: the ventral striatum inferior (VSi) and the ventral striatum superior (VSs), the dorsal-caudal putamen (DCP), the dorsal-rostral putamen (DRP), and the dorsal caudate and the ventral-rostral putamen (VRP). The sliding-window analysis was used to evaluate dFC for each seed.

RESULTS

Both BD II and MDD exhibited increased dFC variability between the left DRP and the left supplementary motor area, and between the right VRP and the right inferior parietal lobule. The BD II had specific increased dFC variability between the right DCP and the left precentral gyrus compared with MDD and HCs. The MDD had increased dFC variability between the left VSi and the left medial prefrontal cortex compared with BD II and HCs.

CONCLUSIONS

The patients with BD and MDD shared common dFC alteration in the dorsal striatal-sensorimotor and ventral striatal-cognitive circuitries. The patients with MDD had specific dFC alteration in the ventral striatal-affective circuitry.

Sex differences in the association between suicide attempts and glucose disturbances in first-episode and drug naive patients with major depressive disorder

BACKGROUND

Glucose metabolism is related to depression, but the relationship between blood glucose and suicide attempts in patients with major depressive disorder (MDD) remains unclear. This large-scale sample explores the relationship between suicide attempts and fasting blood glucose, in addition to sex differences in first-episode and drug naive (FEDN) MDD patients.

METHODS

1718 FEDN MDD patients diagnosed for the first time were recruited, and their demographic data, clinical data, and blood glucose indicators were collected. 17-item Hamilton Depression Rating Scale (HAMD), 14-item Hamilton Anxiety Rating Scale (HAMA), and positive subscale of the Positive and Negative Syndrome Scale (PANSS) were used to assess their depression, anxiety and psychotic symptoms, respectively.

RESULTS

The depression, anxiety, psychotic symptoms and blood sugar levels of the suicide attempt group were higher than those of the non-suicide attempt group. Correlation analysis showed that blood glucose was significantly associated with suicide attempts in male and female patients. While binary logistic regression showed that blood glucose levels were significantly associated with suicide attempts in male patients, it showed that suicide attempts were not significantly associated with blood glucose levels in female patients.

LIMITATIONS

The main limitations are cross-sectional design and inability to control selection bias.

CONCLUSIONS

In male MDD patients, fasting blood glucose level is a potential biomarker of suicide attempt, which deserves attention to avoid suicide risk. However, in female patients, fasting blood glucose has no significant correlation to suicide attempts.

Differential associations of phasic and tonic irritability to suicidality among U.S. adults

Research on the relations between irritability and suicidality among adults has rarely compared or differentiated between tonic versus phasic irritability. The current cross-sectional study investigated the role of both tonic and phasic irritability in relation to lifetime suicidal ideation, plans, and attempts. The study included adult participants who completed the suicidality module from the National Comorbidity Survey - Replication (NCS-R) (N = 7683 for suicidal ideation and N = 1223 for suicidal plan and attempt). The NCS-R used lay-administered, standardized diagnostic interviews. Phasic and tonic irritability were assessed with individual screener items from the World Health Organization Composite International Diagnostic Interviews (CIDI). The current study used logistic regression, weighted Cox proportional hazard model, and multinomial logit regression, adjusting for sex, race/ethnicity, age, education, and marital status. Both types of irritability were included simultaneously in the models. Results indicated that both types of irritability were significantly associated with increased odds of suicidal ideation (phasic: Odds Ratio 2.72 [2.35,3.14]); tonic: OR 2.34 [2.04,2.68]), age of first-time suicidal ideation (phasic: Adjusted Hazard Ratio 2.87 [2.27, 3.63]; tonic: AHR 2.12 [1.76,2.54]), and suicide attempt (phasic: OR 1.53 [1.13,2.07]); tonic: OR 1.44 [1.11,1.89]). Only tonic but not phasic irritability was associated with suicide plans (OR 1.39 [1.08,1.79]). When suicide attempts were divided into those that were impulsive versus planned and compared them to no suicide attempt, both types of irritability were associated planned attempts, (phasic: OR 1.53 [1.13,2.07]); tonic: OR 1.44 [1.11,1.89]) but only phasic irritability was related to impulsive attempts (OR 1.70 [1.10,2.64]). Phasic and tonic irritability show differential relations to and can serve as differential markers for suicide-related outcomes in adults.

Increased Suicidality and Worse Outcomes in MDD Patients With OSA: A Nationwide Inpatient Analysis of 11 Years From 2006 to 2017

BACKGROUND

Major depressive disorder (MDD) is the most common psychiatric disorder characterized by changes in mood, cognition, and physical symptoms. MDD has an approximate 18% prevalence of comorbid OSA. Several studies have looked into plausible mechanisms that have shown a strong relationship between OSA and MDD.

OBJECTIVES

The primary objective of this study was to compare suicidal ideation/attempt among MDD patients with and without a comorbid diagnosis of OSA. The secondary objective was to compare the length of stay, total hospital charge, recurrent or severity of depression, and clinical comorbidities.

METHODS

Data were obtained from the National (Nationwide) Inpatient Sample dataset from 2006 to 2017. For data collection, we queried for all adult patients (age ≥ 18 y), with MDD as a primary indication of admission. Further, we categorized MDD patients with and without a secondary diagnosis of OSA. To reduce the imbalance in baseline characteristics between the groups, we performed one to one age-gender matching between MDD patients with and without OSA.

RESULTS

In the matched cohort, 79,308 patients were included in MDD with OSA and 78,792 patients in the MDD without OSA group. MDD patients with OSA were more likely to be racially white (80% vs 75%, P < 0.001), and to have more clinical comorbidities (hypertension, heart failure, obesity, and chronic lung disease). Prevalence of recurrent type of depression (77% vs 69%, P < 0.001) and moderate to severe depression (72% vs 68%, P < 0.001) was more likely in the MDD with OSA group. Further, suicidality (composite of suicidal ideation/attempt) was more in MDD with OSA (49.5%) compared to MDD without OSA (41.8%) (P < 0.001). In the multivariate analysis, MDD with OSA was associated with higher odds of suicidal ideation/act compared to MDD without OSA (adjusted odds ratio: 1.27, P < 0.001). The total length of stay was longer in the MDD with OSA group (7.4 vs 6.9 d, P < 0.001).

CONCLUSIONS

In our study, poorer outcomes were observed in patients with MDD and OSA. Hence, clinicians should be vigilant for symptoms of OSA in patients with recurrent MDD or treatment-resistant MDD. We recommend that a thorough suicide risk assessment should be conducted in MDD patients with OSA, and validated questionnaires should be a part of the evaluation.

Psychotic symptoms during bipolar depressive episodes and suicidal ideation

BACKGROUND

Psychotic symptoms during bipolar depressive episodes, especially in outpatients, are under recognized and studied by clinicians and researchers. We examined the relationship between psychotic symptoms during a depressive episode and suicidal ideation in bipolar patients.

METHODS

Participants (N = 351) were adult, depressed outpatients with bipolar disorder (BD) in a comparative effectiveness study of quetiapine versus lithium. Psychotic symptoms were assessed via Bipolar Inventory of Signs and Symptoms Scale (BISS) and depressive episodes via Mini-International Neuropsychiatric Interview (MINI). Because only 4.84% (N = 17) endorsed psychotic symptoms, we performed iterative multivariate matching with non-psychotic participants. On every matched population, a multiple regression analysis examined whether psychotic symptoms were associated with suicidal ideation, via the Concise Health Risk Taking scale (CHRT-12).

RESULTS

Averaged across the 50 matched populations, current psychotic symptoms predicted active suicidal ideation on the CHRT, but not a passive propensity toward suicide or total CHRT scores, after adjusting for common correlates of suicidality (e.g., previous suicidal behavior) (β=0.59, p=.01, R2= 0.41).

LIMITATIONS

Our study was limited by three factors. First, the generalizability of our study was limited as the sample included only outpatients. Next, the analysis was cross-sectional and does not allow for causal interpretation. Lastly, our study lacked information regarding the content and mood congruency of participants' psychosis.

CONCLUSION

While a small proportion of BD outpatients had current symptoms of psychosis during their depressive episode, those who did were more likely to endorse active suicidal thoughts, including suicide methods and plans.

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.

Association between irritability and suicidal ideation in three clinical trials of adults with major depressive disorder

Irritability in pediatric samples is associated with higher rates of subsequent suicide-related outcomes. No study, to date, has evaluated the longitudinal association between irritability and suicidal ideation (SI) in adults with major depressive disorder (MDD). This report evaluated whether irritability is associated with SI at the same visit (i.e., concurrently) and whether early changes in irritability with antidepressant treatment predict subsequent levels of SI. Participants of Combining Medications to Enhance Depression Outcomes (CO-MED, n = 665), Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC, n = 296), and Suicide Assessment Methodology Study (SAMS, n = 266) were included. Repeated-measures mixed model analyses evaluated concurrent association throughout the trial between irritability (five-item irritability domain of Concise Associated Symptom Tracking scale) and SI (three-item suicidal thoughts factor of Concise Health Risk Tracking scale) after controlling for overall depression (excluding suicidality-related item), and predicted subsequent levels of SI (repeated observations from week-2-to-week-8) based on early (baseline-to-week-2) changes in irritability after controlling for early changes in overall depression. Higher irritability was associated with higher SI concurrently; estimates (standard error) were 0.18 (0.02, p < 0.0001), 0.64 (0.02, p < 0.0001), and 0.26 (0.04, p < 0.0001) in CO-MED, EMBARC, and SAMS respectively. Greater baseline-to-week-2 reductions in irritability predicted lower levels of subsequent SI; estimates (standard errors) were -0.08 (0.03, p = 0.023), -0.50 (0.05, p < 0.0001), and -0.12 (0.05, p = 0.024) in CO-MED, EMBARC, and SAMS, respectively. Controlling for anxiety or insomnia produced similar results. In conclusion, irritability and SI were consistently linked in adults with MDD. These findings support careful assessment of irritability in suicide risk assessment.

Association of Lipid Profile and Suicide Attempts in a Large Sample of First Episode Drug-Naive Patients With Major Depressive Disorder

Several studies have reported a link between lipid disorders and suicidality. However, few studies have investigated the relationship between suicidal behavior and blood lipid profiles in patients with first-episode and drug-naive (FEDN) major depressive disorder (MDD). The main purpose of this study was to examine the relationship between plasma lipid profiles and suicide attempts in a large sample of FEDN MDD patients in the Chinese Han population, which has not been reported. A total of 1,718 MDD outpatients were recruited. Their clinical and demographic data as well as plasma lipid parameters were collected. We obtained suicide attempt data through interviews with patients and their family members. We rated the Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) for all patients. The suicide attempt rate of MDD patients was 20.14%, of which 13.68% in the last month and 6.46% in the past. Further, compared with non-attempters, suicide attempters had significantly higher total levels of cholesterol (TC) and low-density lipoprotein cholesterol (LDL-c), higher HAMA and HAMD scores, but significantly lower high-density lipoprotein cholesterol (HDL-c) levels. Logistic regression analysis showed that suicide attempts were correlated with higher TC, lower HDL-c, and higher HAMA and HAMD scores with the adjusted odds ratio (OR) of 1.35, 0.52,1.28, and 1.08, respectively (all p < 0.05). Our findings suggest that FEDN patients with MDD have a high rate of attempted suicide. In the early stage of MDD patients, certain blood lipid parameters and more severe symptoms of anxiety and depression are correlated with suicide attempts. However, due to the cross-sectional design of this study, it is impossible to draw a causal relationship between lipid profiles and suicide attempts. Moreover, an inverse correlation can also be considered, that is, high cholesterol may be the consequence of suicide attempts and depression.

Association of thyroid dysfunction with suicide attempts in first-episode and drug naïve patients with major depressive disorder

BACKGROUNDS

Thyroid dysfunction was reported to be associated with depression; however, its role in suicide risk in patients with major depressive disorder (MDD) remains unclear. The objective of this study was to compare thyroid function between suicide attempters and non-suicide attempters in a large sample of first episode drug naïve (FEDN) MDD patients, which received little systemic investigation.

METHODS

A total of 1718 outpatients with diagnosis of MDD at their first episode were recruited. Their socio-demographic, clinical data and thyroid function parameters were collected. The positive subscale of the Positive and Negative Syndrome Scale (PANSS), Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD) were measured for psychotic, anxiety and depressive symptoms, respectively.

RESULTS

Our results showed that compared with non-suicide attempters, suicide attempters had greater scores on HAMD, HAMA and PANSS psychotic symptoms and higher serum levels in thyroid stimulating hormone (TSH), anti-thyroglobulin (TgAb) and thyroid peroxidases antibody (TPOAb) (all p < 0.001). Further logistic regression analysis indicated that suicide attempts were associated with severe anxiety with an adjusted odds ratio (OR) of 2.704 and TPOAb with an adjusted OR of 2.188.

LIMITATIONS

No causal relationship could be drawn due to the cross-sectional design.

CONCLUSIONS

Our results indicate TSH, TgAb and TPOAb may be promising biomarkers of suicide risk in MDD, suggesting the importance of regular assessment of thyroid function parameters for suicide prevention, and possible treatment for impaired thyroid function for intervention of suicide in MDD patients.

Suicide attempts in eating disorder subtypes: a meta-analysis of the literature employing DSM-IV, DSM-5, or ICD-10 diagnostic criteria

BACKGROUND

Quantification of suicidal risk in specific populations is important for the adoption of targeted prevention and harm reduction measures. Though there remains little systematic evidence, risk of suicide attempts for bulimia nervosa (BN) and binge-purging anorexia nervosa (AN-bp) appears higher than restrictive AN (AN-r); risk in binge eating disorder (BED) is still unclear. The aim of this meta-analysis was to compare proportions of suicide attempts in eating disorder (ED) subgroups.

METHODS

A literature search using combinations of key-words for ED and suicide attempts was performed. Studies reporting proportions of suicide attempters in at least two ED groups, diagnosed according to DSM-IV or -5 and ICD-10 diagnostic criteria were considered. ED subgroups were analyzed in pairs using a binary random effect model for proportions. Publication bias, meta-regression, and sensitivity analyses were performed.

RESULTS

In BN, attempted suicide was more frequent (21%) than in AN (12.5%), but the difference was statistically significant only when BN was compared with AN-r (9-10%). In BED, the proportion of suicide attempts was as high as in AN (10-12%).

CONCLUSIONS

Though limited by heterogeneity across the studies in terms of methodology and aims, inability to control for relevant confounding variables, exclusion of ED not otherwise specified, this study supports suicide attempts as a major issue in EDs, especially in binge-purging subtypes, i.e. BN and AN-bp. Similar suicidal proportions were observed in AN and BED. The reasons for a greater proportion of attempted suicide in binge/purging subtypes need to be explored in future studies.

The prevalence, metabolic disturbances and clinical correlates of recent suicide attempts in Chinese inpatients with major depressive disorder

BACKGROUND

Metabolic disturbances have been correlated with suicidality, but little is known about the association between suicide risk and metabolic disturbances among individuals with depression. This study was to evaluate the prevalence and clinical correlations, especially cardio-metabolic associated factors of recent suicide attempts in Chinese patients with major depressive disorder (MDD).

METHODS

A total of 288 MDD inpatients were recruited. Their clinical and demographic data together with plasma glucose, lipid and thyroid function parameters were collected. Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS) and Eysenck Personality Questionnaire (EPQ) were rated for most of the patients.

RESULTS

Of these MDD inpatients, 20.14% had attempted suicide during the past 1 month. Compared to those who had not attempted suicide, the suicide attempters had a significantly longer duration of illness, lower low-density lipoprotein (LDL) cholesterol, lower total cholesterol, and more psychotic symptoms. However, all these significant results did not survive after the bonferroni correction (all p > 0.05). A logistic regression analysis indicated that suicide attempts were associated with the lower total cholesterol and more psychotic symptoms.

CONCLUSIONS

Our findings support the hypothesis of the association of low plasma cholesterol level and recent suicidal attempts in patients with MDD.

Suicidal Risk and Affective Temperaments, Evaluated with the TEMPS-A Scale: A Systematic Review

BACKGROUND

Among risk factors for suicidal behavior, there is growing interest in associations with stable affective temperament types, particularly based on assessment with the TEMPS-A self-rating scale.

AIM

As research on this topic has not been reviewed systematically, we synthesized relevant, reported research findings.

METHODS

Systematic searching identified peer-reviewed reports pertaining to associations of suicidal behavior or ideation with affective temperament types evaluated with TEMPS-A. We summarized available findings and applied quantitative meta-analytic methods to compare scale scores in suicidal versus nonsuicidal subjects.

RESULTS

In 21 of 23 TEMPS-A studies meeting inclusion criteria, anxious, cyclothymic, depressive, or irritable temperament scores were significantly higher with previous or recent suicide attempts or ideation in both psychiatric and general population samples compared to nonsuicidal controls, whereas hyperthymic temperament scores were lower in 9 of 11 reports. These findings were synthesized by random-effects meta-analyses of standardized mean differences in TEMPS-A temperament scores in suicidal versus nonsuicidal subjects. Associations ranked: depressive ≥ irritable > cyclothymic > anxious > hyperthymic (negative).

CONCLUSIONS

Affective temperaments, especially depressive and irritable, were strongly associated with suicidal risk, whereas hyperthymic temperament appeared to be protective.

Association between irritability and suicide-related outcomes across the life-course. Systematic review of both community and clinical studies

BACKGROUND

Irritability is gaining considerable attention as a risk factor for suicide-related outcomes (suicide mortality, attempt, and ideation). However, the evidence of this association is scant. We conducted a systematic review of the evidence regarding the associations between irritability and suicide-related outcomes across the life-course.

METHODS

We conducted a systematic search on Medline and PsycINFO (up to January 2018) for original articles published in English investigating the association between irritability and suicide-related outcomes. Two researchers independently screened the articles, assessed the quality of the evidence (New-Castle-Ottawa Scale) and extracted study characteristics.

RESULTS

Thirty-nine studies were retrieved, most were of low/medium quality. Twelve assessed irritability in childhood/adolescence (6 in community samples, 6 in clinical samples) and 27 in adulthood (7 in community samples, 20 in clinical samples). In both childhood/adolescence and adult samples, most community-based studies reported a positive association between irritability and suicidal ideation and/or attempt, while clinical studies reported mixed findings. More specifically, in clinical studies, the association of irritability with suicide-related outcomes (i) was not supported among adult depressed patients, (ii) findings were inconsistent in adult bipolar patients, (iii) for inpatients/outpatients with various psychiatric disorders/conditions, association was observed in adulthood but not in childhood/adolescence.

LIMITATIONS

Differences in methodology and definition/measurement of irritability limited the comparability of included studies.

CONCLUSIONS

Although irritability has been proposed as a promising transdiagnostic factor associated with suicide-related outcomes, the absence of consensus in the definition of irritability (vs anger or reactive/impulsive aggression), the poor methodological quality, and the lack of developmental considerations mitigate the conclusions.

Mental status and suicide probability of young people: A cross-sectional study

OBJECTIVE

The most important determinant of suicide ideation, tendency and initiative is the presence of mental disorders. Since the number of those who lost their lives due to suicide in the world rose rapidly among the young population, the World Health Organization emphasizes the importance of assessing young people in the high-risk age group to prevent suicidal behavior. This study aimed to determine psychological symptom levels and suicide probability in young people.

METHOD

The cross-sectional research consisted of 15-24 year-old individuals (N=348), who have sought a psychiatric clinic between February and June, 2015. The Research Data was collected by applying Data Collection Form, Suicide Probability Scale (SPS) and Brief Symptom Inventory (BSI). SPSS 22.0 statistical package program was used for data analysis.

RESULTS

There was a statistically significant difference (p<0.05) between the mean SPS scores according to education, psychiatric treatment, self-harm, smoking and drinking status of the participants in the study. Apart from this, there was also a statistically significant correlation between anxiety, depression, negative self and hostility according to the SPS and BSI subscales (p<0.001, r=0.739; p<0.001, r=0.729; p<0.001, r=0.747; p<0.001, r=0.715; respectively).

CONCLUSION

The results of our study show that suicide risk is significantly higher in young people with depression, anxiety, negative self-perception and hostility symptoms. In this regard, we suggest the relevance of assessing the suicide risk of young people seeking a psychiatric clinic, with thorough attention to those who have high potential for suicide.

Risk Factors for Recent Suicide Attempts in Major Depressive Disorder Patients in China: Results From a National Study

Objective: To analyze the factors associated with recent suicide attempts including socio-demographic and clinical characteristics in major depressive disorder (MDD) patients in China. Methods: The data were from a nationwide sample from 13 major psychiatric hospitals or the psychiatric units of general hospitals in China, from September 1, 2010 to February 28, 2011. Melancholic features and suicide attempts in the past month were defined according to the melancholic feature module and the suicide module of the Mini International Neuropsychiatric Interview (MINI). Socio-demographic and clinical characteristics were compared between MDD patients with and without recent suicide attempts. Further analyses regarding the factors associated with recent suicide attempts in MDD patients were performed via multivariate logistic regression analysis. Results: Among 1,172 MDD patients, 57 (4.9%) were reported to have made a suicide attempt in the past month. Compared to the MDD patients without recent suicide attempt, significantly higher percentage of patients in the recent suicide attempters group had previous suicide attempts (χ² = 171.861, p < 0.001) and depressive episodes with melancholic features (χ² = 22.837, p < 0.001). Logistic regression analysis indicated that previous suicide attempts (OR = 20.81, 95% CI: 11.12-38.94, p < 0.001) and depressive episodes with melancholic features (OR = 4.43, 95% CI: 2.09-9.43, p < 0.001) were independently associated with recent suicide attempts in MDD patients. Limitations: Cross-sectional design, retrospective recall of suicide attempt data. Conclusion: Recent suicide attempts are associated with melancholic features and previous suicide attempts in MDD patients in China. These data may help clinicians to identify MDD patients at high risk of suicide attempt behavior.

[What can we expect from clinical trials in psychiatry?]

Clinical trials in psychiatry allow to build the regulatory dossiers for market authorization but also to document the mechanism of action of new drugs, to build pharmacodynamics models, evaluate the treatment effects, propose prognosis, efficacy or tolerability biomarkers and altogether to assess the impact of drugs for patient, caregiver and society. However, clinical trials have shown some limitations. Number of recent dossiers failed to convince the regulators. The clinical and biological heterogeneity of psychiatric disorders, the pharmacokinetic and pharmacodynamics properties of the compounds, the lack of translatable biomarkers possibly explain these difficulties. Several breakthrough options are now available: quantitative system pharmacology analysis of drug effects variability, pharmacometry and pharmacoepidemiology, Big Data analysis, brain modelling. In addition to more classical approaches, these opportunities lead to a paradigm change for clinical trials in psychiatry.

Taking care of oneself by regaining control - a key to continue living four to five decades after a suicide attempt in severe depression

BACKGROUND

Depression is a strong risk factor for suicide and suicide attempt. Several studies have examined the pathway to suicide attempt, but few studies have considered aspects important for overcoming being suicidal. The aim of the present study was to examine personal strategies to continue living after a suicide attempt.

METHODS

A qualitative grounded theory approach was used. Thirteen former inpatients diagnosed with severe depression (1956-1969) participated in a follow-up 42-56 years after their last suicide attempt, which occurred between the ages of 21 and 45. They were interviewed on one occasion between June 2013 and January 2014, using semi-structured interviews.

RESULTS

The pathway to a suicide attempt was defined as 'being trapped in an overwhelming situation'. Three categories described the recovery process: 'coming under professional care', 'experiencing relief in the personal situation', and 'making a decision to continue living'. These categories emerged in a core category, labelled 'taking care of oneself by regaining control'. Overcoming being suicidal occurred regardless of recovering from depression.

CONCLUSION

In the very long-term course following a suicide attempt, the process of recovery is multi-dimensional and fluctuating, and includes appropriate treatment, connecting with others, decision making, and overcoming existential issues.

Affective temperaments and suicidal ideation and behavior in mood and anxiety disorder patients

BACKGROUND

Clinical characteristics proposed to be associated with suicidal risk include affective temperament types. We tested this proposal with two methods in a large sample of subjects with mood and anxiety disorders.

METHODS

We assessed consecutive, consenting subjects clinically for affective temperament types and by TEMPS-A self-ratings for associations of temperament with suicidal ideation and acts, using standard bivariate methods, and multivariate logistic regression models.

RESULTS

Among 2561 subjects (major depressive, 1171; bipolar, 919, anxiety disorders, 471), temperament-types and TEMPS-A (39-item Italian version) subscale scores differed by risk of suicidal acts or ideation. Suicidal acts and ideation were most associated with cyclothymic and dysthymic, and less with hyperthymic temperaments. These associations were sustained by multivariate modeling that included diagnosis, age, sex, and diagnosis.

LIMITATIONS

Not all subjects completed TEMPS-A self-ratings; clinical assessments of temperaments were not standardized, and long-term stability of temperament assessments was not tested.

CONCLUSIONS

The findings support and extend associations of cyclothymic-dysthymic temperaments with suicidal acts and ideation, whereas hyperthymic temperament may be protective.

The connection of temperament with ADHD occurrence and persistence into adulthood - An investigation in 18 year old males

BACKGROUND

This study intended to determine whether certain traits of temperament are associated with former and current ADHD symptomatology in a non-clinical sample of 18 year old males.

METHODS

We performed a cross sectional descriptive study of 3280 men during the examination for military service. The investigation included a socio-demographic questionnaire, screening for substance abuse, temperament (TEMPS-M), past (WURS) and current (ADHD symptom checklist) ADHD symptomatology.

RESULTS

We found a correlation of cyclothymic (p<.001), irritable (p<.001) and anxious (p<.05) temperament with occurrence and severity of past and present ADHD symptomatology. No significant correlation has been detected for hyperthymic and depressive temperament. Judged retrospectively, ADHD symptoms were strongly consistent over time.

LIMITATIONS

The sample consists of men only. These had to be fit enough to be enlisted for military service; men with severe mental or physical disorders were thus excluded. Furthermore, the cross-sectional study design does not allow making conclusions about the temporal relationships between ADHD symptoms and substance misuse.

CONCLUSIONS

These results indicate that a temperament based approach towards those affected by ADHD might be useful. Subtyping ADHD by integrating temperament profiles in diagnosis and treatment of the disorder could help explain some of the heterogeneity of the disease.

Anxious temperament as a risk factor of suicide attempt

OBJECTIVE

Suicide has been reported to be associated with cyclothymic, irritable, depressive and anxious temperaments. In contrast, hyperthymic temperament has been reported to be protective against suicide. In the present study, we hypothesized that Japanese patients with suicide attempt may have higher scores of cyclothymic, irritable, depressive, and anxious temperaments but lower scores of hyperthymic temperament than non-suicidal patients. In order to examine this hypothesis, we investigated Japanese patients of a university emergency center.

METHODS

The association of temperament and suicide attempt was investigated in 116 patients referred to a university emergency center for intoxication or injury. Of them, 35 patients of suspected suicide attempt were categorized as 18 patients who intended to die with attempted suicide and suffered from self-inflicted but not fatal injury (Suicide Attempt II), 4 patients whose intention to die were undetermined although they suffered from self-inflicted injury (Undetermined Suicide-Related Behavior II), and 13 patients who had no intention to die although they suffered from self-inflicted injury (Self-Harm II). Logistic regression analyses and multiple regression analyses were used to identify factors associated with the present suicide attempt and the number of suicide attempts, respectively.

RESULTS

Anxious temperament scores were significantly and directly associated with Suicide Attempt II group whereas irritable temperament scores were associated with Self-Harm II group.

CONCLUSION

The present findings suggest that those with anxious temperament may have more suicide attempts than those with other temperaments, indicating anxious temperament as a risk factor of suicide attempt.

Early Maladaptive Schemas in Bipolar Disorder Patients With and Without Suicide Attempts

Patients with bipolar disorder (BD) are at an increased risk of attempted and completed suicide. To elucidate the beliefs and assumptions associated with suicidality in BD, the present study compared BD patients with and without a history of suicide attempt in terms of early maladaptive schemas (EMSs). The sample consisted of 49 remitted BD patients who completed the Young Schema Questionnaire-Short Version. Information on suicide attempts was obtained through interviews combined with medical records. Compared with BD patients without suicide attempts, the BD patients with suicide attempts scored significantly higher on 3 EMSs: social isolation, practical incompetence, and entitlement. The findings suggest that specific EMSs may be implicated in suicidal behaviors in BD. These results have implications for the assessment and treatment of suicidality in BD.

The Role of Temperament in the Etiopathogenesis of Bipolar Spectrum Illness

Bipolar disorder constitutes a challenge for clinicians in everyday clinical practice. Our knowledge concerning this clinical entity is incomplete, and contemporary classification systems are unable to reflect the complexity of this disorder. The concept of temperament, which was first described in antiquity, provides a helpful framework for synthesizing our knowledge on how the human body works and what determines human behavior. Although the concept of temperament originally included philosophical and sociocultural approaches, the biomedical model is dominant today. It is possible that specific temperaments might constitute vulnerability factors, determine the clinical picture, or modify the course of illness. Temperaments might even act as a bridge between genes and clinical manifestations, thus giving rise to the concept of the bipolar spectrum, with major implications for mental health research and treatment. More specifically, it has been reported that the hyperthymic and the depressive temperaments are related to the more "classic" bipolar disorder, whereas cyclothymic, anxious, and irritable temperaments are related to more complex manifestations and might predict poor response to treatment, violent or suicidal behavior, and high comorbidity. Incorporating of the concept of temperament and the bipolar spectrum into the standard training of psychiatric residents might well result in an improvement of everyday clinical practice.

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

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.

Temperament and suicide: A national study

BACKGROUND

Several studies have shown temperament variants in suicidality. Yet, to our knowledge, the association between temperaments and suicide attempts has not been studied on a nationally representative level nor systematically in subjects with no mental disorders. Also, although hyperthymic temperament is recognized as protective of most mental disorders, its role in the protection from self-harm remains inconclusive.

METHODS

The study is based on nationally representative data of all Lebanese adults. Mental disorders were assessed using the Composite International Diagnostic Interview, whereas the five affective temperaments were assessed using the TEMPS-A.

RESULTS

Anxious temperament is a solid and strong risk factor for suicide attempts in subjects with (OR: 10.1) and without (OR: 9.0) mental disorders. Depressive (OR: 4.3) and irritable (OR: 5.1) temperaments are risk factors for suicide attempt among subjects with mental disorders. Hyperthymic temperament plays a dual role in females with mental disorders: while the hyperthymic trait "having self-confidence" is strongly protective of suicide attempts, "liking to be the boss", "getting into heated arguments", and "the right and privilege to do as I please" are hyperthymic risk traits for suicide attempts reflecting the "dark side" of the hyperthymic temperament. Interestingly, these three hyperthymic risk traits--in the absence of "having self-confidence"--are a universal risk for suicide attempt in females with mental disorder.

LIMITATIONS

Social desirability could have led to the under-reporting of suicide attempts and mental disorders.

CONCLUSIONS

The anxious temperament plays a strong role in predicting suicide attempts in the community, in the presence and absence of diagnosable mental disorders. The irritable and the depressive temperaments are additional risks in subjects with mental disorders. The dual role of the hyperthymic temperament is quite interesting: while it is protective of suicidal behavior, it also has a dark side in subjects with mental disorders.

Antidepressants worsen rapid-cycling course in bipolar depression: A STEP-BD randomized clinical trial

BACKGROUND

The use of antidepressants in rapid-cycling bipolar disorder has been controversial. We report the first randomized clinical trial with modern antidepressants on this topic.

METHODS

As part of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study, we analyzed, as an a priori secondary outcome, rapid cycling as a predictor of response in 68 patients randomized to continue vs. discontinue antidepressant treatment, after initial response for an acute major depressive episode. Outcomes assessed were percent time well and total number of episodes. All patients received standard mood stabilizers.

RESULTS

In those continued on antidepressants (AD), rapid cycling (RC) subjects experienced 268% (3.14/1.17) more total mood episodes/year, and 293% (1.29/0.44) more depressive episodes/year, compared with non-rapid cycling (NRC) subjects (mean difference in depressive episodes per year RC vs. NRC was 0.85 ± 0.37 (SE), df = 28, p = 0.03). In the AD continuation group, RC patients also had 28.8% less time in remission than NRC patients (95% confidence intervals (9.9%, 46.5%), p = 0.004). No such differences between RC and NRC subjects were seen in the AD discontinuation group (Table 1). Analyses within the rapid-cycling subgroup alone were consistent with the above comparisons between RC and NRC subjects, stratified by maintenance antidepressant treatment, though limited by sample size.

CONCLUSIONS

In an a priori analysis, despite preselection for good antidepressant response and concurrent mood stabilizer treatment, antidepressant continuation in rapid-cycling was associated with worsened maintenance outcomes, especially for depressive morbidity, vs. antidepressant discontinuation.

Cyclothymia reloaded: A reappraisal of the most misconceived affective disorder

Data emerging from both academic centers and from public and private outpatient facilities indicate that from 20% to 50% of all subjects that seek help for mood, anxiety, impulsive and addictive disorders turn out, after careful screening, to be affected by cyclothymia. The proportion of patients who can be classified as cyclothymic rises significantly if the diagnostic rules proposed by the DSM-5 are reconsidered and a broader approach is adopted. Unlike the DSM-5 definition based on the recurrence of low-grade hypomanic and depressive symptoms, cyclothymia is best identified as an exaggeration of cyclothymic temperament (basic mood and emotional instability) with early onset and extreme mood reactivity linked with interpersonal and separation sensitivity, frequent mixed features during depressive states, the dark side of hypomanic symptoms, multiple comorbidities, and a high risk of impulsive and suicidal behavior. Epidemiological and clinical research have shown the high prevalence of cyclothymia and the validity of the concept that it should be seen as a distinct form of bipolarity, not simply as a softer form. Misdiagnosis and consequent mistreatment are associated with a high risk of transforming cyclothymia into severe complex borderline-like bipolarity, especially with chronic and repetitive exposure to antidepressants and sedatives. The early detection and treatment of cyclothymia can guarantee a significant change in the long-term prognosis, when appropriate mood-stabilizing pharmacotherapy and specific psychological approaches and psychoeducation are adopted. The authors present and discuss clinical research in the field and their own expertise in the understanding and medical management of cyclothymia and its complex comorbidities.

Predominant polarity in bipolar disorders: Further evidence for the role of affective temperaments

BACKGROUND

Literature suggests bipolars may differ in several features according to predominant polarity, but the role of temperaments remains controversial.

METHODS

The EPIDEP study was designed to identify bipolar patients among a large sample of major depressives. Only bipolars were included in the current study. Patients were subtyped as predominantly depressive (PD) and predominantly manic and hypomanic (PM) according to a broad (more episodes of a given polarity) and a narrow (2/3 of episodes of one polarity over the other) definition, and compared on their characteristics.

RESULTS

Among 278 bipolars, 182 (79.8%) could be subtyped as PD and 46 (20.2%) as PM (broad definition); the respective proportions were of 111 (81.6%) and 25 (18.4%) using narrow definition. Expanding the definition added little in detecting differences between groups. Compared to PDs, PMs showed more psychosis, rapid cycling, stressors at onset, family history of affective illness, and manic first episode polarity; they also received more antipsychotics and lithium. The PDs showed more chronic depression, comorbid anxiety, and received more antidepressants, anticonvulsants and benzodiazepines. The following independent variables were associated with manic/hypomanic predominant polarity: cyclothymic temperament, first hospitalization≤25 years, hyperthymic temperament, and alcohol use (only for broad definition).

LIMITATION

Cross-sectional design, recall bias.

CONCLUSIONS

Study findings are in accord with literature except for suicidality and mixicity which were related to predominant mania, and explained by higher levels of cyclothymic and hyperthymic temperaments. Temperaments may play a key role in the subtyping of bipolar patients according to predominant polarity, which warrants confirmation in prospective studies.

Is duration of illness really influencing outcome in major psychoses?

BACKGROUND

An increasing number of studies identifies the duration of illness (DI) as an important predictor of outcome in patients affected by major psychoses (MP). The aim of the present paper was to revise medical literature about DI and its effects on MP, focusing in particular on the relationship between DI and outcome with particular reference to treatment response, suicidal risk, cognitive impairment and social functioning.

METHODS

A search in the main database sources has been performed to obtain a comprehensive overview. Studies with different methodologies (open and double-blinded) have been included, while papers considering other variables such as duration of untreated episode/illness were excluded. MP included the diagnoses of schizophrenia, bipolar disorder and major depressive disorder.

RESULTS

Available data show that DI influences treatment response, suicidal risk and loss of social functioning in schizophrenic patients, while results are more controversial with regard to cognitive impairment. In bipolar disorder, a long DI has been associated with less treatment response, more suicidal risk and cognitive impairment, but more data are needed to draw definitive conclusions. Finally, studies, regarding DI of illness and its predictive value of outcome in major depressive disorder show contradictory results.

CONCLUSIONS

DI appears a negative outcome factor particularly for schizophrenia, while with regard to mood disorders, more data are needed to draw definitive sound conclusions.

Risk factors for suicide in bipolar disorder: a systematic review

BACKGROUND

Bipolar disorder confers the highest risk of suicide among major psychological disorders. The risk factors associated with bipolar disorder and suicide exist and are relevant to clinicians and researchers.

OBJECTIVE

The aim of the present study was to conduct a systematic review of articles regarding the suicide risk factors in bipolar disorder.

METHODS

A systematic review of articles on suicide risk factors in bipolar disorder, published from January 1, 2010 to April 05, 2014, on SCOPUS and PUBMED databases was carried out. Search terms were "Suicide" (medical subject headings [MeSH]), "Risk factors" (MeSH), and "Bipolar" (keyword). Of the 220 retrieved studies, 42 met the eligibility criteria.

RESULTS

Bipolar disorder is associated with an increased rate death by suicide which contributes to overall mortality rates. Studies covered a wide range of aspects regarding suicide risk factors in bipolar disorder, such as risk factors associated to Sociodemographic conditions, Biological characteristics, Drugs Relationships, Psychological Factors, Genetic Compound, Religious and Spirituals conditions. Recent scientific literature regarding the suicide risk factors in bipolar disorder converge to, directly or indirectly, highlight the negative impacts of risk factors to the affected population quality of life.

CONCLUSION

This review demonstrated that Bipolar disorders commonly leads to other psychiatric disorders and co-morbidities involving risk of suicide. Thus the risk factors are relevant to have a better diagnosis and prognosis of BD cases involving risk of suicide.

Suicidal behavior in german adolescents. Prevalence and association with depressive and manic symptoms

OBJECTIVE

Research in adults has identified an association between bipolar disorder and suicidal behavior. This relationship, however, has been insufficiently investigated in adolescents to date.

METHODS

1,117 adolescents from 13 German schools (mean age = 14.83, SD = .63; 52.7% females) completed an extended German version of the Center for Epidemiological Studies Depression Scale (CES-D), which assesses depressive and manic symptoms during the last week, as well as the Self-Harm Behavior Questionnaire (SHBQ) for the assessment of lifetime suicidal behavior.

RESULTS

In the present sample 39.4% of the girls and 23.1% of the boys reported lifetime suicidal thoughts and 7.1% of the girls as well as 3.9% of the boys a lifetime history of suicide attempts. 18.7% of the adolescent sample revealed elevated symptoms of depression and 9% elevated levels of mania symptoms. Elevated sum scores of depression and mania were associated with a higher number of suicidal ideations and suicide attempts. A block-wise regression analysis revealed that sum scores of depression and mania predicted suicidal ideations best. Concerning suicide attempts, the best predictors were age as well as depression and mania sum scores.

CONCLUSIONS

Suicidal behavior was reported more often when adolescents demonstrate symptoms of mania as well as symptoms of depression than when they demonstrate only depressive symptoms. The presence of bipolar symptoms in adolescents should alert clinicians to the heightened possibility of suicidal behavior.

Suicidal behavior in adolescents and adults with bulimia nervosa

BACKGROUND

Recent evidence suggests increased risk for mortality in bulimia nervosa (BN). However, little is yet known about suicidal behavior in BN.

AIMS

To examine frequency and correlates of suicidal ideation and attempts in adolescents and adults with BN in two population-based samples.

METHOD

A total of 10,123 adolescents and 2980 adults in two nationally representative surveys of mental disorder were queried regarding eating disorder symptoms and suicidal ideation and attempts.

RESULTS

Less than 1 percent (0.9%) of adolescents and 1.0% of adults met the criteria for BN. Suicidal ideation was more common among adolescents with BN (53.0%) compared with those with binge eating disorder (BED) (34.4%), other psychopathology (21.3%) or no psychopathology (3.8%). Similar trends emerged for the association between BN and self-reported suicidal plans or attempts. Among adults, suicidality was more common in BN than in the no psychopathology group, but not significantly different from the anorexia nervosa (AN), BED, or other psychopathology subgroups.

CONCLUSION

There is a high risk of suicidal ideation and behavior among those with BN. These results underscore the importance of addressing suicide risk in adolescents and adults with eating disorder symptoms.

Suicidal Ideation, Suicidal Plan and Suicidal Attempts Among Those with Major Depressive Disorder

Introduction: The aims of the study were to identify the prevalence and sociodemographic and clinical correlates of suicidal behaviours using data from a cross-sectional survey among those with major depressive disorder (MDD) in Singapore. Materials and Methods: The Singapore Mental Health Study (SMHS) was a cross-sectional epidemiological study that surveyed Singapore residents (Singapore citizens and permanent residents) aged 18 years and above. The assessment of mental disorders was established using version 3.0 of the Composite International Diagnostic Interview (CIDI 3.0). For the purposes of this study, suicidal behaviour was assessed by questions which were asked to respondents who answered positively to the screening questions in the CIDI 3.0 “Depression” module. Results: The prevalence of suicidal ideation, plan and attempt among those with lifetime MDD was 43.6%, 13.7% and 12.3%, respectively. We found that suicidal ideation, plan and attempt were significantly associated with ethnicity, education and income. The rate of those who had sought some professional help was higher among those with suicidal plan (71.7%) and attempt (72.3%) as compared to those with suicidal ideation (48.7%) and those with MDD but no suicidal behaviour (29%). Conclusion: Individuals with MDD and suicidal behaviour do differ from their non-suicidal counterparts as they have a different sociodemographic and clinical profile. There is a need for more research and a better understanding of this population which in turn could lead to the development and implementation of relevant interventions. Key words: Composite International Diagnostic Interview, Depression, Prevalence, Singapore Mental Health Study, Suicidal behaviour

The Relationship of Childhood Abuse and Neglect with Suicide Attempts in an Adult Unipolar Depression Sample

INTRODUCTION

Unipolar depression is an important psychiatric disorder that leads to an increased risk of suicide. However, not all depression patients attempt suicide. This reflects the presence of other factors that may be related to suicide other than the sole presence of psychopathology. Drawing upon the clinical evidence linking childhood abuse and neglect experiences with suicide; this study aimed at investigating the relationship of childhood abuse and neglect experiences with suicide attempts in patients with unipolar depression.

METHOD

One hundred six unipolar depressed patients between the ages of 18 and 65 were included in the study. Patients with comorbid psychiatric disorders, neurological disorders, alcohol-substance abuse problems, and a Beck Depression Inventory (BDI) score of <17 were excluded from the study. The BDI, Childhood Trauma Questionnaire (CTQ-28), State-Trait Anger Expression Inventory (STAXI), and the Suicide Behavior Questionnaire (SBQ) were administered to all patients. Suicidal and non-suicidal cases were determined according to clinic interviews and the patients' responses in the SBQ.

RESULTS

Sixty-four patients have previously attempted suicide. Although there was no significant difference between unipolar depression patients with a history of suicide attempts and patients with no history of suicide attempts in terms of average age, education and marital status, however, female/male ratio in the former group was determined to be significantly higher. BDI, STAXI continuous anger and outward anger average scores, and average CTQ-28 emotional abuse, physical abuse and total scores were significantly higher in the group with a history of suicide attempts. The predictors of suicide attempts were higher BDI and CTQ-28 physical abuse scores and female gender. The predictors for average SBQ scores were determined as higher BDI, CTQ-28 sexual abuse, and STAXI outward anger and continuous anger scores.

CONCLUSION

Childhood physical and sexual abuse experiences are important factors in evaluating the presence of suicide attempts and risk of suicide in patients with unipolar depression. Careful questioning of traumatic childhood experiences during psychiatric examinations and monitoring of depression patients is crucial in determining treatment protocols and preventing suicide attempts.

Residual symptoms and functional performance in a large sample of euthymic bipolar patients in France (the OPTHYMUM study)

BACKGROUND

Some residual symptoms were found to be associated with impaired functioning in euthymic bipolar patients, but their impact and relevance are unclear in clinical practice. We re-examined the functional influence of a large set of residual symptoms in 525 euthymic bipolar outpatients using self- and clinician-rated questionnaires (OPTHYMUM study).

METHODS

This was a multi-centre, cross-sectional, non-interventional study of adult bipolar outpatients. All patients were euthymic at the time of assessment (YMRS score <8 and BDRS ≤8). Patients with low functioning (GAF score <60) were compared with the rest of the sample. Patients filled in specific questionnaires concerning their perceptions of different residual and subsyndromal symptoms.

RESULTS

Ninety-seven (97) psychiatrists included 525 patients. Of them, 35 patients had a GAF score <60. These "low functioning patients" were more frequently unemployed, had presented more manic episodes and psychotic symptoms, used more atypical antipsychotics or benzodiazepines and received less adjunctive psychotherapy. Concerning residual symptoms, they had more frequent emotional subsyndromal symptoms, disruption of circadian rhythms and sexual disorders. They perceived some cognitive deficits and suffered more social and family stigma.

LIMITATIONS

Our study used an arbitrary GAF cut-off score (60) to separate bipolar patients in two groups (low and satisfactory functioning).

CONCLUSIONS

Residual symptoms are associated with functional impairment and may represent specific treatment targets. A personalized approach through specific psychotherapeutic programs may lead to more efficient support by the clinician.

Suicidal behaviour in mood disorders--who, when, and why?

OBJECTIVE

About one-half to two-thirds of all suicides are by people who suffer from mood disorders; preventing suicides among those who suffer from them is thus central for suicide prevention. Understanding factors underlying suicide risk is necessary for rational preventive decisions.

METHOD

The literature on risk factors for completed and attempted suicide among subjects with depressive and bipolar disorders (BDs) was reviewed.

RESULTS

Lifetime risk of completed suicide among psychiatric patients with mood disorders is likely between 5% and 6%, with BDs, and possibly somewhat higher risk than patients with major depressive disorder. Longitudinal and psychological autopsy studies indicate suicidal acts usually take place during major depressive episodes (MDEs) or mixed illness episodes. Incidence of suicide attempts is about 20- to 40-fold, compared with euthymia, during these episodes, and duration of these high-risk states is therefore an important determinant of overall risk. Substance use and cluster B personality disorders also markedly increase risk of suicidal acts during mood episodes. Other major risk factors include hopelessness and presence of impulsive-aggressive traits. Both childhood adversity and recent adverse life events are likely to increase risk of suicide attempts, and suicidal acts are predicted by poor perceived social support. Understanding suicidal thinking and decision making is necessary for advancing treatment and prevention.

CONCLUSION

Among subjects with mood disorders, suicidal acts usually occur during MDEs or mixed episodes concurrent with comorbid disorders. Nevertheless, illness factors can only in part explain suicidal behaviour. Illness factors, difficulty controlling impulsive and aggressive responses, plus predisposing early exposures and life situations result in a process of suicidal thinking, planning, and acts.

Suicide risk in major affective disorder: results from a national survey in China

BACKGROUND

This study investigated suicide risk and its correlates among major affective disorder patients in China and examined possible risk factors for future suicide among individuals with major affective disorder to inform appropriate interventions and management approaches to minimize and prevent suicide.

METHODS

A total of 1478 major affective disorder patients were consecutively examined in 13 mental health centers in China. The patients' socio-demographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. DSM-IV diagnoses were established using the Mini International Neuropsychiatric Interview (MINI), and suicide risk was assessed by the suicide risk module of the MINI.

RESULTS

Of the patients, 963 (65.2%) were in the nonsuicidal risk group and 515 (34.8%) were in the suicidal risk group. Compared to major depressive disorder patients, bipolar disorder patients had higher suicide risk levels (χ2=10.0, df=1, P=0.002); however, there were no statistically significant differences (χ2=2.6, df=1, P=0.1) between bipolar disorder-I and bipolar disorder-II patients. Suicide risk factors were associated with 6 variables in major affective disorder patients, as follows: male gender, unemployed, more frequent depressive episodes (>4 in the past year), depressive episodes with suicidal ideation and attempts, depressive episodes with psychotic symptoms, and no current antidepressant use.

LIMITATIONS

Most of the data were retrospectively collected and, therefore, subject to recall bias.

CONCLUSIONS

This study suggested that bipolar disorder patients have a higher suicide risk than major depressive disorder patients. The factors that were significantly associated with suicide risk may aid in identifying major affective disorder patients who are at risk for future suicidal behavior.

Characteristics and profiles of bipolar I patients according to age-at-onset: findings from an admixture analysis

BACKGROUND

Many studies have used admixture analysis to separate age-at-onset (AAO) subgroups in bipolar patients, but few have looked at the phenomenological characteristics of these subgroups, in order to find out phenotypic markers.

METHODS

Admixture analysis was applied to identify the model best fitting the observed AAO distribution of a sample of 1082 consecutive DSM-IV bipolar I manic inpatients who were assessed for demographic, clinical, course of illness, comorbidity, and temperamental characteristics.

RESULTS

The model best fitting the observed distribution of AAO was a mixture of three Gaussian distributions. We could identify three AAO subgroups: early, intermediate, and late age-at-onset (EAO, IAO, and LAO, respectively). Patients in the EAO subgroup were more often single young males exhibiting severe mania with psychotic features, a subcontinuous course of illness with substance use and panic comorbidity, more suicide attempts, and temperamental components sharing hypomanic features. Patients with LAO showed a less severe picture with more depressive temperamental components, alcohol use and comorbid general medical conditions. A less typical phenotype was present in IAO patients.

LIMITATIONS

The following are the limitations of this study: retrospective design, and bias toward preferential enrollment of patients with manic predominant polarity.

CONCLUSIONS

This study confirms that bipolar I disorder can be subdivided into three subgroups based on AAO distribution and shows that patients from these subgroups differ in phenotypes.