Multi-national research identifies behaviors associated with suicide

Research presented at the European College of Neuropsychopharmacology Congress indicate behavior patterns associated with suicide, which may aid clinicians in identifying patients who will eventually attempt suicide.

Dina Popovic, PhD, of the University of Barcelona in Barcelona, and colleagues conducted standard mental health interviews among 2,811 patients with depression — 628 of whom had attempted suicide — to identify history of suicide, family history, current and previous treatment, clinical presentation and Global Assessment of Functioning scale scores.

Analysis indicated depressive mixed states often preceded attempted suicide, as more patients who attempted suicide exhibited depressive mixed states than those who did not attempt suicide.

Past responses to antidepressants of patients who attempted suicide included more hypomanic switches (OR = 1.97; 95% CI, 1.58-2.44), treatment resistance (OR = 2.07; 95% CI, 1.72-2.49), mood lability (OR = 1.98; 95% CI, 1.65-2.39) and irritability (OR = 1.8; 95% CI, 1.48-2.17).

Hypomanic symptoms associated with attempted suicide included risky behavior (OR = 2.11; 95% CI, 1.51-2.97), psychomotor agitation (OR = 1.452; 95% CI, 1.14-1.86; P = .003) and impulsivity (OR = 1.267; 95% CI, 0.97-1.66).

Borderline personality disorder and substance abuse disorder were comorbid diagnoses most commonly associated with attempted suicide.

Researchers found that standard DSM criteria identified 11.9% of patients as exhibiting depressive mixed states, whereas their method of analysis identified 39.8% of patients with depressive mixed states.

“This means that the standard methods are missing a lot of patients at risk of suicide,” Popovic said in a press release.

“In our opinion, assessing these symptoms in every depressed patient we see is extremely important, and has immense therapeutical implications. Most of these symptoms will not be spontaneously referred by the patient, the clinician needs to inquire directly, and many clinicians may not be aware of the importance of looking at these symptoms before deciding to treat depressed patients,” Popovic said. “This is an important message for all clinicians, from the [general practitioners] who see depressed patients and may not pay enough attention to these symptoms, which are not always reported spontaneously by the patients, through to secondary and tertiary level clinicians. In highly specialized tertiary centers, clinicians working with bipolar patients are usually more aware of this, but that practice needs to extend to all levels.” – by Amanda Oldt

Disclosure: The researchers report Sanofi-Aventis sponsored the study and was involved in study design, conduct, monitoring, and preparation of the final data base, but not in content.

Reference:

Popovic D, et al. Suicidal behavior in major depressive episode: evidence from the BRIDGE-II-MIX study. Presented at: European College of Neuropsychopharmacology Congress; Aug. 29-Sept. 1, 2015; Amsterdam.