Suicidal risk factors in major affective disorders
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. We considered risk factors before, during and after intake assessments of 3284 adults with/without suicidal acts, overall...
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| Veröffentlicht in: | British journal of psychiatry 2019-10, Vol.215 (4), p.621-626 |
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| creator | Baldessarini, Ross J. Tondo, Leonardo Pinna, Marco Nuñez, Nicholas Vázquez, Gustavo H. |
| description | 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.
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.
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.
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. |
| doi_str_mv | 10.1192/bjp.2019.167 |
| format | Article |
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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.
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.
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.</description><identifier>ISSN: 0007-1250</identifier><identifier>EISSN: 1472-1465</identifier><identifier>DOI: 10.1192/bjp.2019.167</identifier><identifier>PMID: 31292010</identifier><language>eng</language><publisher>Cambridge, UK: Cambridge University Press</publisher><subject>Abuse ; Affective disorders ; Age of onset ; Alcohol abuse ; Antidepressants ; Antipsychotics ; Attention deficit hyperactivity disorder ; Bipolar disorder ; Child abuse & neglect ; Confidence intervals ; Conflicts of interest ; Depressive personality disorders ; Emotional disorders ; Emotions ; Hospitalization ; Hyperactivity ; Lethality ; Medical diagnosis ; Mental depression ; Mood ; Mood disorders ; Psychiatry ; Ratios ; Risk behavior ; Risk factors ; Substance abuse ; Suicidal ideation ; Suicide ; Suicides & suicide attempts ; Temperament ; Trauma ; Unemployment ; Variance analysis</subject><ispartof>British journal of psychiatry, 2019-10, Vol.215 (4), p.621-626</ispartof><rights>Copyright © The Royal College of Psychiatrists 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c358t-2b133ebf23556722863897d4f81d1d18bc41d3fc4cb5e03882c414d0d8608f33</citedby><cites>FETCH-LOGICAL-c358t-2b133ebf23556722863897d4f81d1d18bc41d3fc4cb5e03882c414d0d8608f33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.cambridge.org/core/product/identifier/S0007125019001673/type/journal_article$$EHTML$$P50$$Gcambridge$$H</linktohtml><link.rule.ids>164,314,780,784,12845,27343,27923,27924,30998,33773,55627</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31292010$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baldessarini, Ross J.</creatorcontrib><creatorcontrib>Tondo, Leonardo</creatorcontrib><creatorcontrib>Pinna, Marco</creatorcontrib><creatorcontrib>Nuñez, Nicholas</creatorcontrib><creatorcontrib>Vázquez, Gustavo H.</creatorcontrib><title>Suicidal risk factors in major affective disorders</title><title>British journal of psychiatry</title><addtitle>Br J Psychiatry</addtitle><description>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.
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.
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.
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.</description><subject>Abuse</subject><subject>Affective disorders</subject><subject>Age of onset</subject><subject>Alcohol abuse</subject><subject>Antidepressants</subject><subject>Antipsychotics</subject><subject>Attention deficit hyperactivity disorder</subject><subject>Bipolar disorder</subject><subject>Child abuse & neglect</subject><subject>Confidence intervals</subject><subject>Conflicts of interest</subject><subject>Depressive personality disorders</subject><subject>Emotional disorders</subject><subject>Emotions</subject><subject>Hospitalization</subject><subject>Hyperactivity</subject><subject>Lethality</subject><subject>Medical diagnosis</subject><subject>Mental depression</subject><subject>Mood</subject><subject>Mood disorders</subject><subject>Psychiatry</subject><subject>Ratios</subject><subject>Risk behavior</subject><subject>Risk factors</subject><subject>Substance abuse</subject><subject>Suicidal ideation</subject><subject>Suicide</subject><subject>Suicides & suicide attempts</subject><subject>Temperament</subject><subject>Trauma</subject><subject>Unemployment</subject><subject>Variance analysis</subject><issn>0007-1250</issn><issn>1472-1465</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>BHHNA</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNptkM9LwzAUx4Mobk5vnqXgxYOteUmapkcZ_oKBB3cPaX5IarvOZBX8783YVBB5h_DCJ9_38kHoHHABUJObpl0XBENdAK8O0BRYRXJgvDxEU4xxlQMp8QSdxNimljJSHaMJBVKnN3iKyMvotTeqy4KPb5lTejOEmPlV1qt2CJlyzuqN_7CZ8XEIxoZ4io6c6qI9258ztLy_W84f88Xzw9P8dpFrWopNThqg1DaO0LLkFSGCU1FXhjkBJpVoNANDnWa6KS2mQpB0wQw2gmPhKJ2hq13sOgzvo40b2fuobdeplR3GKAkpOWAOdZXQyz9oO4xhlZaThFLBai7S12foekfpMMQYrJPr4HsVPiVguVUpk0q5VSmTyoRf7EPHprfmB_52l4Bin6f6Jnjzan_H_pv4BZMhe2c</recordid><startdate>20191001</startdate><enddate>20191001</enddate><creator>Baldessarini, Ross J.</creator><creator>Tondo, Leonardo</creator><creator>Pinna, Marco</creator><creator>Nuñez, Nicholas</creator><creator>Vázquez, Gustavo H.</creator><general>Cambridge University Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7QJ</scope><scope>7TK</scope><scope>7U3</scope><scope>7XB</scope><scope>88G</scope><scope>88J</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BHHNA</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HEHIP</scope><scope>M2M</scope><scope>M2O</scope><scope>M2R</scope><scope>M2S</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20191001</creationdate><title>Suicidal risk factors in major affective disorders</title><author>Baldessarini, Ross J. ; Tondo, Leonardo ; Pinna, Marco ; Nuñez, Nicholas ; Vázquez, Gustavo H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c358t-2b133ebf23556722863897d4f81d1d18bc41d3fc4cb5e03882c414d0d8608f33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Abuse</topic><topic>Affective disorders</topic><topic>Age of onset</topic><topic>Alcohol abuse</topic><topic>Antidepressants</topic><topic>Antipsychotics</topic><topic>Attention deficit hyperactivity disorder</topic><topic>Bipolar disorder</topic><topic>Child abuse & neglect</topic><topic>Confidence intervals</topic><topic>Conflicts of interest</topic><topic>Depressive personality disorders</topic><topic>Emotional disorders</topic><topic>Emotions</topic><topic>Hospitalization</topic><topic>Hyperactivity</topic><topic>Lethality</topic><topic>Medical diagnosis</topic><topic>Mental depression</topic><topic>Mood</topic><topic>Mood disorders</topic><topic>Psychiatry</topic><topic>Ratios</topic><topic>Risk behavior</topic><topic>Risk factors</topic><topic>Substance abuse</topic><topic>Suicidal ideation</topic><topic>Suicide</topic><topic>Suicides & suicide attempts</topic><topic>Temperament</topic><topic>Trauma</topic><topic>Unemployment</topic><topic>Variance analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baldessarini, Ross J.</creatorcontrib><creatorcontrib>Tondo, Leonardo</creatorcontrib><creatorcontrib>Pinna, Marco</creatorcontrib><creatorcontrib>Nuñez, Nicholas</creatorcontrib><creatorcontrib>Vázquez, Gustavo H.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection</collection><collection>ProQuest Central (Corporate)</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Neurosciences Abstracts</collection><collection>Social Services Abstracts</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Psychology Database (Alumni)</collection><collection>Social Science Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Social Science Premium Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Sociological Abstracts</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>Sociology Collection</collection><collection>ProQuest Psychology Journals</collection><collection>ProQuest Research Library</collection><collection>ProQuest Social Science Journals</collection><collection>Sociology Database</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baldessarini, Ross J.</au><au>Tondo, Leonardo</au><au>Pinna, Marco</au><au>Nuñez, Nicholas</au><au>Vázquez, Gustavo H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Suicidal risk factors in major affective disorders</atitle><jtitle>British journal of psychiatry</jtitle><addtitle>Br J Psychiatry</addtitle><date>2019-10-01</date><risdate>2019</risdate><volume>215</volume><issue>4</issue><spage>621</spage><epage>626</epage><pages>621-626</pages><issn>0007-1250</issn><eissn>1472-1465</eissn><abstract>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.
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.
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.
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.</abstract><cop>Cambridge, UK</cop><pub>Cambridge University Press</pub><pmid>31292010</pmid><doi>10.1192/bjp.2019.167</doi><tpages>6</tpages></addata></record> |
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| source | Sociological Abstracts; Applied Social Sciences Index & Abstracts (ASSIA); Cambridge Journals Online; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Abuse Affective disorders Age of onset Alcohol abuse Antidepressants Antipsychotics Attention deficit hyperactivity disorder Bipolar disorder Child abuse & neglect Confidence intervals Conflicts of interest Depressive personality disorders Emotional disorders Emotions Hospitalization Hyperactivity Lethality Medical diagnosis Mental depression Mood Mood disorders Psychiatry Ratios Risk behavior Risk factors Substance abuse Suicidal ideation Suicide Suicides & suicide attempts Temperament Trauma Unemployment Variance analysis |
| title | Suicidal risk factors in major affective disorders |
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