Factors associated with single versus multiple suicide attempts in depressive disorders

Tondo, Leonardo; Baldessarini, Ross J.; Barbuti, Margherita; Colombini, Paola; Angst, Jules; Azorin, Jean‐Michel; Bowden, Charles L.; Mosolov, S.; Young, Allan H.; Vieta, Eduard; Perugi, Giulio

doi:10.1016/j.jad.2020.08.021

Cited by 15 publications

(7 citation statements)

References 57 publications

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“…It is especially notable that suicide risk remains high among BD patients despite the growing array of effective psychopharmacological and psychosocial treatments available for the disorder 23,24 . Indeed, up to 60% of persons with BD attempt suicide at some time, and suicide fatalities occur in 5%–20% of adults with BD 25–27 . The high suicidal risk with BD is further underscored by findings that the rate of suicide attempts is approximately twice that associated with MDD, in which suicidal risk varies greatly with illness severity 16 .…”

Section: Epidemiologymentioning

confidence: 99%

“…For mood disorder patients, previous suicide attempt is a most powerful predictor of future suicidal behavior: approximately, 40% of people die of suicide after a previous suicide attempt 2,26–28 . Moreover, risk of suicide after an attempt has been estimated at 1.6% within a year of an attempt and about 4% within 5 years, whereas the risk for an another attempt was about 16% within 1 year 28,29 .…”

Section: Risk Factorsmentioning

confidence: 99%

“…Other clinical features associated with risk of suicide behavior in BD include depressive initial episodes which are strongly or moderately correlated with later predominant depressive morbidity, as well as treatment‐resistant depressions, hopelessness, and dysthymic or cyclothymic (but not hyperthymic) temperament, impulsivity, and aggressiveness, lack of interpersonal or clinical support, psychiatric hospitalization, borderline personality features, but inconsistently with features associated with narcissistic personality disorder (Table 2). 15,25,27,36–39 Family history of suicidal behavior, as well as childhood trauma, emotional abuse and neglect, as well as gender confusion also represent important predictors of later suicidal behavior 2,8 . Quantitative estimates of associations of a range of clinical factors with risk of suicide and attempts are provided as the ratio of their presence in mood disorder patients with versus without suicidal acts (Table 2).…”

Section: Risk Factorsmentioning

confidence: 99%

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Prevention of suicidal behavior in bipolar disorder

2020

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Background Excess mortality is a critical hallmark of bipolar disorder (BD) due to co‐occurring general medical disorders and especially from suicide. It is timely to review of the status of suicide in BD and to consider the possibility of limiting suicidal risk. Methods We carried out a semi‐systematic review of recent research reports pertaining to suicide in BD. Findings Suicide risk in BD is greater than with most other psychiatric disorders. Suicide rates (per 100,000/year) are approximately 11 and 4 in the adult and juvenile general populations, but over 200 in adults, and 100 among juveniles diagnosed with BD. Suicide attempt rates with BD are at least 20 times higher than in the adult general population, and over 50 times higher among juveniles. Notable suicidal risk factors in BD include: previous suicidal acts, depression, mixed–agitated‐dysphoric moods, rapid mood‐shifts, impulsivity, and co‐occurring substance abuse. Suicide‐preventing therapeutics for BD remain severely underdeveloped. Evidence favoring lithium treatment is stronger than for other measures, although encouraging findings are emerging for other treatments. Conclusions Suicide is a leading clinical challenge for those caring for BD patients. Improved understanding of risk and protective factors combined with knowledge and close follow‐up of BD patients should limit suicidal risk. Ethically appropriate and scientifically sound studies of plausible medicinal, physical, and psychosocial treatments aimed at suicide prevention specifically for BD patients are urgently needed.

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Section: Epidemiologymentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

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Prevention of suicidal behavior in bipolar disorder

2020

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“…Likewise, a greater degree of association has been found between hopelessness and SAs when there is in fact a history of SAs [ 34 , 35 , 36 , 37 , 38 ]. Previous attempts can be considered to be a powerful predictor of subsequent attempts because they substantially increase the risk after a first SA [ 35 , 41 , 42 , 43 ]. Thus, hopelessness, SI, and SAs are among the main factors associated with the increased risk of SB [ 34 , 36 , 37 , 39 , 40 , 41 , 42 , 43 ], and consequently these three components are key for the evaluation of suicide risk in females exposed to IPV.…”

Section: Introductionmentioning

confidence: 99%

Suicidal Behaviour as an Emerging Factor in Female Victims of Gender-Based Violence within a Relationship: An Exploratory Study

Puig-Amores

Gordillo

Parra

2022

IJERPH

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Intimate partner violence (IPV), in addition to being an important public health problem, is a risk factor for suicidal behaviour (SB). The objective of this study was to explore the risk of suicidal behaviour associated with the different forms of abuse and the consequences derived from it. This exploratory study was conducted on a sample of women who experienced IPV (N = 70) in the Extremadura Region (Spain). Demographic factors, abuse experience, suicidal ideation (SI), suicidal communication (SC), and suicide attempts (SAs) were analysed according to the type of abuse. We found that a very high prevalence of psychological violence (IPVp) was accompanied, in most cases, by some other type of abuse (IPVp+). Additionally, a significant relationship was found between IPV and SB. Logistic regression revealed a greater risk of SI and SA in the IPVp+ group. The results of this study could be useful to healthcare service professionals in preventing suicidal behaviour.

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“…Apparently, the introduction of the mixed features specifier has increased the prevalence of MSs in clinical practice [6], urgently calling for clinical trials and the development of new recommendations for the treatment of MSs [7]. Mixed features are associated with worse outcomes and treatment resistance [8,9], higher risk of suicide [10,11], aggressiveness [12], affective lability [13], higher rates of recurrences [14,15], inversion to overt mania or hypomania [16], and increased cyclicity [17].…”

Section: Introductionmentioning

confidence: 99%

Electroconvulsive Therapy (ECT) in Bipolar Disorder Patients with Ultra-Rapid Cycling and Unstable Mixed States

Born

Grunze

2021

Medicina

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Background and Objectives: Unstable mixed episodes or rapid switching between opposite affective poles within the scope of short cycles was first characterized in 1967 by S. Mentzos as complex polymorphous states with chaotic overlap of manic and depressive symptoms. Well-known examples include antidepressant-induced mania/hypomania and rapid/ultra-rapid/ultradian cycling, when clinicians observe an almost continuous mixed state with a constant change of preponderance of manic or depressive symptoms. Achieving stable remission in these cases is challenging with almost no data on evidence-based treatment. When mood stabilizers are ineffective, electroconvulsive therapy (ECT) has been suggested. Objectives: After reviewing the evidence from available literature, this article presents our own clinical experience of ECT efficacy and tolerability in patients with ultra-rapid cycling bipolar disorder (BD) and unstable mixed states. Materials and Methods: We conducted an open, one-year observational prospective study with a “mirror image” design, including 30 patients with rapid and ultra-rapid cycling BD on long-term mood stabilizer treatment (18 received lithium carbonate, 6 on valproate and 6 on carbamazepine) with limited effectiveness. A bilateral ECT course (5–10 sessions) was prescribed for regaining mood stability. Results: ECT was very effective in 12 patients (40%) with a history of ineffective mood stabilizer treatment who achieved and maintained remission; all of them received lithium except for 1 patient who received carbamazepine and 2 with valproate. Nine patients (30%) showed partial response (one on carbamazepine and two on valproate) and nine patients (30%) had no improvement at all (four on carbamazepine and two on valproate). For the whole sample, the duration of affective episodes was significantly reduced from 36.05 ± 4.32 weeks in the year prior to ECT to 21.74 ± 12.14 weeks in the year post-ECT (p < 0.001). Depressive episodes with mixed and/or catatonic features according to DSM-5 specifiers were associated with a better acute ECT response and/or long-term mood stabilizer treatment outcome after ECT. Conclusions: ECT could be considered as a useful option for getting mood instability under control in rapid and ultra-rapid cycling bipolar patients. Further randomized trials are needed to confirm these results.

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Factors associated with single versus multiple suicide attempts in depressive disorders

Cited by 15 publications

References 57 publications

Prevention of suicidal behavior in bipolar disorder

Prevention of suicidal behavior in bipolar disorder

Suicidal Behaviour as an Emerging Factor in Female Victims of Gender-Based Violence within a Relationship: An Exploratory Study

Electroconvulsive Therapy (ECT) in Bipolar Disorder Patients with Ultra-Rapid Cycling and Unstable Mixed States

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