Ross J Baldessarini1, Marco Innamorati2, Denise Erbuto3, Gianluca Serafini4, Andrea Fiorillo5, Mario Amore4, Paolo Girardi3, Maurizio Pompili6. 1. International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA. Electronic address: rbaldessarini@mclean.harvard.edu. 2. Department of Human Sciences, European University of Rome, Rome, Italy. 3. Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy. 4. Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics, and Infant-Maternal Science, University of Genoa, Genoa, Italy. 5. Department of Psychiatry, University of Naples SUN, Naples, Italy. 6. International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA; Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
Abstract
BACKGROUND: Affective temperaments are associated with suicidal risk, but their predictive value relative to diagnosis of major affective disorder is uncertain. METHODS: We compared diagnoses, affective-temperament ratings (TEMPS-A), and other potential risk factors in 956 psychiatric inpatients, using bivariate analyses and multivariable logistic regression modeling for associations with suicidal status. RESULTS: Lifetime suicide-attempt rates were high (43.9% overall), ranking by diagnosis: bipolar-II (58.4%), major depressive (50.0%), bipolar-I (44.6%), other (38.0%), and psychotic (33.9%) disorders. TEMPS-A scores for depressive (dep), cyclothymic (cyc), irritable (irr), and anxious (anx) temperaments and their sum were strongly associated with suicidal risk; hyperthymic (hyp) temperament scores were inversely associated; and a composite measure (dep+cyc+irr+anx - hyp), even more strongly associated. The composite score was highly, independently associated with suicidal behavior (p<0.0001), as was female sex (p=0.0002), but older age and diagnosis of major affective disorder, much less (both p=0.02). CONCLUSIONS: Measures of affective temperament-types were independently and more strongly associated with lifetime suicide attempt than was diagnosis of a major affective disorder. However, in this hospitalized cohort, suicide rates were high across diagnoses, possibly limiting the predictive value of diagnosis.
BACKGROUND: Affective temperaments are associated with suicidal risk, but their predictive value relative to diagnosis of major affective disorder is uncertain. METHODS: We compared diagnoses, affective-temperament ratings (TEMPS-A), and other potential risk factors in 956 psychiatric inpatients, using bivariate analyses and multivariable logistic regression modeling for associations with suicidal status. RESULTS: Lifetime suicide-attempt rates were high (43.9% overall), ranking by diagnosis: bipolar-II (58.4%), major depressive (50.0%), bipolar-I (44.6%), other (38.0%), and psychotic (33.9%) disorders. TEMPS-A scores for depressive (dep), cyclothymic (cyc), irritable (irr), and anxious (anx) temperaments and their sum were strongly associated with suicidal risk; hyperthymic (hyp) temperament scores were inversely associated; and a composite measure (dep+cyc+irr+anx - hyp), even more strongly associated. The composite score was highly, independently associated with suicidal behavior (p<0.0001), as was female sex (p=0.0002), but older age and diagnosis of major affective disorder, much less (both p=0.02). CONCLUSIONS: Measures of affective temperament-types were independently and more strongly associated with lifetime suicide attempt than was diagnosis of a major affective disorder. However, in this hospitalized cohort, suicide rates were high across diagnoses, possibly limiting the predictive value of diagnosis.
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