Elizabeth D Ballard1, Jennifer L Vande Voort1,2, David A Luckenbaugh1, Rodrigo Machado-Vieira1, Mauricio Tohen3, Carlos A Zarate1. 1. Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA. 2. Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA. 3. Department of Psychiatry and Behavioral Sciences, Health Sciences Center, University of New Mexico, Albuquerque, NM, USA.
Abstract
OBJECTIVES: Suicide is unfortunately common in psychiatric practice, but difficult to predict. The present study sought to assess which clinical symptoms increase in the months before suicidal behavior in a sample of psychiatric outpatients with bipolar disorder. METHODS: Data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) trial were used. A total of 103 participants who attempted suicide or died by suicide during the trial were included; a 15% random sample of the remaining participants (n = 427) was used as a comparison sample. Linear mixed models in the six months before suicidal behavior were conducted for each of five proposed acute risk factors for suicidal behavior. Participants were assessed using the Clinical Monitoring Form (CMF) at each visit for the following potential acute risk factors for suicidal behavior: suicidal ideation, loss of interest, anxiety, psychomotor agitation, and high-risk behavior. RESULTS: Each of the five symptoms was elevated overall in individuals who engaged in suicidal behavior (p < 0.05). The severity of both suicidal ideation and loss of interest significantly increased in the months before suicidal behavior (p < 0.001). Anxiety demonstrated comparable effect sizes across multiple models. Psychomotor agitation and high-risk behavior were not significantly elevated before suicidal behavior. CONCLUSIONS: Suicidal ideation, loss of interest and, to a lesser extent, anxiety may represent acute suicide risk factors up to four months before suicidal behavior in outpatients with bipolar disorder. Further investigation of these potential acute risk factors in prospective analyses is warranted. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.
RCT Entities:
OBJECTIVES: Suicide is unfortunately common in psychiatric practice, but difficult to predict. The present study sought to assess which clinical symptoms increase in the months before suicidal behavior in a sample of psychiatric outpatients with bipolar disorder. METHODS: Data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) trial were used. A total of 103 participants who attempted suicide or died by suicide during the trial were included; a 15% random sample of the remaining participants (n = 427) was used as a comparison sample. Linear mixed models in the six months before suicidal behavior were conducted for each of five proposed acute risk factors for suicidal behavior. Participants were assessed using the Clinical Monitoring Form (CMF) at each visit for the following potential acute risk factors for suicidal behavior: suicidal ideation, loss of interest, anxiety, psychomotor agitation, and high-risk behavior. RESULTS: Each of the five symptoms was elevated overall in individuals who engaged in suicidal behavior (p < 0.05). The severity of both suicidal ideation and loss of interest significantly increased in the months before suicidal behavior (p < 0.001). Anxiety demonstrated comparable effect sizes across multiple models. Psychomotor agitation and high-risk behavior were not significantly elevated before suicidal behavior. CONCLUSIONS: Suicidal ideation, loss of interest and, to a lesser extent, anxiety may represent acute suicide risk factors up to four months before suicidal behavior in outpatients with bipolar disorder. Further investigation of these potential acute risk factors in prospective analyses is warranted. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.
Authors: K Mikael Holma; Jari Haukka; Kirsi Suominen; Hanna M Valtonen; Outi Mantere; Tarja K Melartin; T Petteri Sokero; Maria A Oquendo; Erkki T Isometsä Journal: Bipolar Disord Date: 2014-03-17 Impact factor: 6.744
Authors: E Samuel Winer; Michael R Nadorff; Thomas E Ellis; Jon G Allen; Steve Herrera; Taban Salem Journal: Psychiatry Res Date: 2014-04-16 Impact factor: 3.222
Authors: A Dumais; A D Lesage; M Alda; G Rouleau; M Dumont; N Chawky; M Roy; J J Mann; C Benkelfat; Gustavo Turecki Journal: Am J Psychiatry Date: 2005-11 Impact factor: 18.112
Authors: Ayal Schaffer; Erkki T Isometsä; Leonardo Tondo; Doris H Moreno; Gustavo Turecki; Catherine Reis; Frederick Cassidy; Mark Sinyor; Jean-Michel Azorin; Lars Vedel Kessing; Kyooseob Ha; Tina Goldstein; Abraham Weizman; Annette Beautrais; Yuan-Hwa Chou; Nancy Diazgranados; Anthony J Levitt; Carlos A Zarate; Zoltán Rihmer; Lakshmi N Yatham Journal: Bipolar Disord Date: 2014-10-20 Impact factor: 6.744
Authors: Elizabeth O'Connor; Bradley N Gaynes; Brittany U Burda; Clara Soh; Evelyn P Whitlock Journal: Ann Intern Med Date: 2013-05-21 Impact factor: 25.391
Authors: J John Mann; Victoria A Arango; Shelli Avenevoli; David A Brent; Frances A Champagne; Paula Clayton; Dianne Currier; Donald M Dougherty; Fatemah Haghighi; Susan E Hodge; Joel Kleinman; Thomas Lehner; Francis McMahon; Eve K Mościcki; Maria A Oquendo; Ganshayam N Pandey; Jane Pearson; Barbara Stanley; Joseph Terwilliger; Amy Wenzel Journal: Biol Psychiatry Date: 2009-02-07 Impact factor: 13.382
Authors: Elizabeth D Ballard; Kathleen Wills; Níall Lally; Erica M Richards; David A Luckenbaugh; Tessa Walls; Rezvan Ameli; Mark J Niciu; Nancy E Brutsche; Lawrence Park; Carlos A Zarate Journal: J Affect Disord Date: 2017-04-25 Impact factor: 4.839
Authors: Siyan Fan; Elizabeth T C Lippard; Anjali Sankar; Amanda Wallace; Jennifer A Y Johnston; Fei Wang; Brian Pittman; Linda Spencer; Maria A Oquendo; Hilary P Blumberg Journal: J Affect Disord Date: 2018-11-22 Impact factor: 4.839
Authors: Elizabeth D Ballard; Cristan A Farmer; Bridget Shovestul; Jennifer Vande Voort; Rodrigo Machado-Vieira; Lawrence Park; Kathleen R Merikangas; Carlos A Zarate Journal: Bipolar Disord Date: 2019-12-09 Impact factor: 5.345
Authors: Xenia Gonda; Jane Sarginson; Nora Eszlari; Peter Petschner; Zoltan G Toth; Daniel Baksa; Gabor Hullam; Ian M Anderson; J F William Deakin; Gabriella Juhasz; Gyorgy Bagdy Journal: Sci Rep Date: 2017-10-10 Impact factor: 4.379