Ross J Baldessarini1, Leonardo Tondo2, Marco Pinna3, Nicholas Nuñez4, Gustavo H Vázquez5. 1. Director,International Consortium for Research on Mood and Psychotic Disorders,McLean Hospital; andProfessor,Department of Psychiatry,Harvard Medical School,USA. 2. Investigator,International Consortium for Research on Mood and Psychotic Disorders,McLean Hospital;Research Associate,Department of Psychiatry,Harvard Medical School,USA;Director,Lucio Bini Mood Disorders Centers,Italy; andInvestigator,Centre for Affective Disorders,Department of Psychological Medicine,Institute of Psychiatry,King's College,London,UK. 3. Investigator,Lucio Bini Mood Disorders Centers,Italy. 4. Investigator,Department of Psychiatry,Queen's University School of Medicine,Canada. 5. Investigator,International Consortium for Research on Mood and Psychotic Disorders,McLean Hospital,USA; andProfessor,Department of Psychiatry,Queen's University School of Medicine,Canada.
Abstract
BACKGROUND: Rates and risk factors for suicidal behaviour require updating and comparisons among mood disorders.AimsTo identify factors associated with suicidal risk in major mood disorders. METHOD: We considered risk factors before, during and after intake assessments of 3284 adults with/without suicidal acts, overall and with bipolar disorder (BD) versus major depressive disorder (MDD), using bivariate comparisons, multivariable regression modelling and receiver operating characteristic (ROC) analysis. RESULTS: Suicidal prevalence was greater in BD versus MDD: ideation, 29.2 versus 17.3%; attempts, 18.8 versus 4.78%; suicide, 1.73 versus 0.48%; attempts/suicide ratio indicated similar lethality, 10.9 versus 9.96. Suicidal acts were associated with familial BD or suicide, being divorced/unmarried, fewer children, early abuse/trauma, unemployment, younger onset, longer illness, more dysthymic or cyclothymic temperament, attention-deficit hyperactivity disorder (ADHD), substance misuse, mixed features, hospital admission, percentage time unwell, less antidepressants and more antipsychotics and mood stabilisers. Logistic regression found five independent factors: hospital admission, more depression at intake, BD diagnosis, onset age ≤25 years and mixed features. These factors were more associated with suicidal acts in BD than MDD: percentage time depressed/ill, alcohol misuse, >4 pre-intake depressions, more dysthymic/cyclothymic temperament and prior abuse/trauma. ADHD and total years ill were similar in BD and MDD; other factors were more associated with MDD. By ROC analysis, area under the curve was 71.3%, with optimal sensitivity (76%) and specificity (55%) with any two factors. CONCLUSIONS: Suicidal risks were high in mood disorders: ideation was highest with BD type II, attempts and suicides (especially violent) with BD type I. Several risk factors for suicidal acts differed between BD versus MDD patients.Declaration of interestNo author or immediate family member has financial relationships with commercial entities that might appear to represent potential conflicts of interest with the information presented.
BACKGROUND: Rates and risk factors for suicidal behaviour require updating and comparisons among mood disorders.AimsTo identify factors associated with suicidal risk in major mood disorders. METHOD: We considered risk factors before, during and after intake assessments of 3284 adults with/without suicidal acts, overall and with bipolar disorder (BD) versus major depressive disorder (MDD), using bivariate comparisons, multivariable regression modelling and receiver operating characteristic (ROC) analysis. RESULTS: Suicidal prevalence was greater in BD versus MDD: ideation, 29.2 versus 17.3%; attempts, 18.8 versus 4.78%; suicide, 1.73 versus 0.48%; attempts/suicide ratio indicated similar lethality, 10.9 versus 9.96. Suicidal acts were associated with familial BD or suicide, being divorced/unmarried, fewer children, early abuse/trauma, unemployment, younger onset, longer illness, more dysthymic or cyclothymic temperament, attention-deficit hyperactivity disorder (ADHD), substance misuse, mixed features, hospital admission, percentage time unwell, less antidepressants and more antipsychotics and mood stabilisers. Logistic regression found five independent factors: hospital admission, more depression at intake, BD diagnosis, onset age ≤25 years and mixed features. These factors were more associated with suicidal acts in BD than MDD: percentage time depressed/ill, alcohol misuse, >4 pre-intake depressions, more dysthymic/cyclothymic temperament and prior abuse/trauma. ADHD and total years ill were similar in BD and MDD; other factors were more associated with MDD. By ROC analysis, area under the curve was 71.3%, with optimal sensitivity (76%) and specificity (55%) with any two factors. CONCLUSIONS: Suicidal risks were high in mood disorders: ideation was highest with BD type II, attempts and suicides (especially violent) with BD type I. Several risk factors for suicidal acts differed between BD versus MDDpatients.Declaration of interestNo author or immediate family member has financial relationships with commercial entities that might appear to represent potential conflicts of interest with the information presented.
Entities:
Keywords:
Bipolar disorders; major depression; risk factors; suicide; suicide attempt
Authors: Louise Öhlund; Michael Ott; Robert Lundqvist; Mikael Sandlund; Ellinor Salander Renberg; Ursula Werneke Journal: Ther Adv Psychopharmacol Date: 2020-08-06
Authors: Leonardo Tondo; Martin Alda; Michael Bauer; Veerle Bergink; Paul Grof; Tomas Hajek; Ute Lewitka; Rasmus W Licht; Mirko Manchia; Bruno Müller-Oerlinghausen; René E Nielsen; Marylou Selo; Christian Simhandl; Ross J Baldessarini Journal: Int J Bipolar Disord Date: 2019-07-22
Authors: John J Söderholm; J Lumikukka Socada; Tom Rosenström; Jesper Ekelund; Erkki T Isometsä Journal: Front Psychiatry Date: 2020-04-17 Impact factor: 4.157
Authors: Carmenrita Infortuna; Francesco Gratteri; Andrew Benotakeia; Sapan Patel; Alex Fleischman; Maria Rosaria Anna Muscatello; Antonio Bruno; Rocco Antonio Zoccali; Eileen Chusid; Zhiyong Han; Fortunato Battaglia Journal: Int J Environ Res Public Health Date: 2020-09-11 Impact factor: 3.390