Predictors of suicidal ideation trajectories in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study

Bloomfield-Clagett, Bartholt; Greenstein, Dede; Kush, Joseph M.; Musci, Rashelle J.; Zarate, Carlos A.; Ballard, Elizabeth D.

doi:10.1016/j.jpsychires.2022.01.027

Cited by 11 publications

(3 citation statements)

References 29 publications

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“…Such a missing information could have hindered the identification of bipolar spectrum cases and the assessment of their impact on suicidality. A recent analysis based on the Sequenced Treatment Alternatives to Relieve Depression study has supported the prognostic role of anhedonia and anxiety, which were associated with negative and positive SI trajectories respectively (Bloomfield-Clagett et al , 2022). These findings were not replicated in the current study but further research is warranted using larger samples and specific tools for the assessment of anhedonia and anxiety/related manifestations.…”

Section: Discussionmentioning

confidence: 96%

Persistence of suicidal ideation within acute phase treatment of major depressive disorder: analysis of clinical predictors

Olgiati

Serretti

2022

International Clinical Psychopharmacology

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Suicidal ideation (SI) is common in major depressive disorder (MDD), and it is a risk factor for suicidal behaviour. Antidepressants are effective in reducing SI, but in some subjects, SI may persist for weeks. This study aimed to disentangle the contribution of baseline clinical characteristics in SI nonremission at week 6. Research involved 198 outpatients with MDD and SI collected within the Combining Medications to Enhance Depression Outcomes trial and treated with different antidepressant combinations. Although SI decreased from baseline to week 6 (P < 0.0001), 78 patients (39%) failed to achieve SI remission. Insomnia [OR, 0.72; 95% confidence interval (CI), 0.52–0.99], reduced need for sleep (OR, 0.75; 95% CI, 0.58–0.99), self-confidence (OR, 0.52; 95% CI, 0.32–0.82), cheerfulness (OR, 0.57; 95% CI, 0.33–0.98), and comorbid panic disorder (OR, 0.93; 95% CI, 0.87–0.99) at baseline were associated with lack of SI remission after controlling for baseline depression and SI scores. The combination of baseline SI and insomnia was moderately effective in predicting the lack of SI remission, with a specificity of 80% (95% CI, 72–87%) and an NPV of 68% (95% CI, 63–72%). In individuals with MDD and SI, the presence of insomnia and bipolar features should prompt a search for more effective treatment solutions in order to favour SI remission and prevent suicidal behaviour.

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Section: Discussionmentioning

confidence: 96%

Persistence of suicidal ideation within acute phase treatment of major depressive disorder: analysis of clinical predictors

Olgiati

Serretti

2022

International Clinical Psychopharmacology

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“…On the other hand, sleep-onset insomnia has also been related to anxiety ( Bragantini et al ., 2019 ), which seems to have a positive prognostic significance in depressive disorders. For instance, in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, patients with MDD and higher levels of anxiety were associated with more favourable SI trajectories during antidepressant treatment ( Bloomfield-Clagett et al ., 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical correlates and prognostic implications of severe suicidal ideation in major depressive disorder

Olgiati

Fanelli

Serretti

2023

International Clinical Psychopharmacology

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Suicidal ideation (SI) is a risk factor for suicidal behaviour. To ascertain the clinical correlates and prognostic impact of severe SI, we analysed 249 outpatients with major depressive disorder (MDD) and suicidal thoughts included in the COmbining Medications to Enhance Depression outcome (CO-MED) trial. Patients with severe SI (36%) were younger at disease onset (P = 0.0033), more severely depressed (P = 0.0029), had more lifetime suicidal behaviour (P < 0.0001) and psychiatric comorbidities (panic disorder: P = 0.0025; post-traumatic stress disorder: P = 0.0216), and a history of childhood maltreatment (neglect: P = 0.0054; emotional abuse: P = 0.0230; physical abuse: P = 0.0076; sexual abuse: P = 0.0016) than those experiencing low-moderate SI. After controlling for depression score, severe SI was positively correlated with lifetime suicidal behaviour (OR [95% CI]: 1.26 [1.12–1.41]), panic disorder (1.05 [1.00–1.12]), and childhood maltreatment (neglect: 1.93 [1.13–3.30]; physical abuse: 2.00 [1.11–3.69]; sexual abuse: 2.13 [1.17–3.88]), and inversely correlated with age of onset (0.97 [0.95–0.99]) and sleep-onset insomnia (0.76 [0.61–0.96]). Finally, the occurrence of serious lifetime suicidal behaviour was predicted by SI severity (2.18 [1.11-4.27]), bipolar score (1.36 [1.02–1.81]), and childhood sexual abuse (2.35 [1.09–5.05]). These results emphasise the importance of assessing childhood maltreatment and bipolar liability in MDD to estimate suicidal behaviour risk.

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“…Previous studies identi ed distinct ideation trajectories following psychiatric inpatient hospitalization for suicide risk [7] to active-duty personnel in a treatment trial and linking these trajectories to suicide attempts during follow-up [8]. However, there is no study focused on the short-term effect of hospitalization among psychiatric patients following hospitalization.…”

Section: Introductionmentioning

confidence: 99%

Rapid reduction of nurse-rated suicidality among psychiatric patients shortly following hospitalization

Ma,

Liang,

Sun

et al. 2024

Preprint

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Background Suicidality is a major reason for psychiatric hospitalization but there have been no studies of the short-term changes in suicidality following psychiatric admission. To assess the short-term changes in suicidality during the first three days after psychiatric admission, when medications and other specific therapies are not likely to have taken effect and the primary benefit is likely to be from hospitalization. Methods A retrospective study of inpatients at risk for suicide was based on nurse-rated suicide assessments documented in medical records at a large psychiatric hospital in southern China. Suicidality was assessed with the Nurses' Global Assessment of Suicide Risk (NGASR) every day (1–3) following admission. Reduction of suicidality from first- to third-day were compared by using McNemar’s Chi-square tests and T-tests, followed by logistic regression to identify correlates of having high risk on day 3 following admission. Results The sample (n = 562) showed a relatively high level of average suicidality (NGASR = 9.2 ± 3.3) at admission with 33.8% reporting a prior suicide attempt. Significant reductions in suicidality were apparent by the third hospital day compared to baseline with NGASR-5 change items score declining from 6.3 ± 2.8 to 4.6 ± 3.0 (p < .001, Cohen’s d = .578), indicating a moderately large change. Compared with those unemployed, being currently employed was associated with greater reduction in likelihood of being at high-risk on day 3 (OR = .568, 95%CI [.361, .895], p = .015). Conclusion This study demonstrates short-term substantial reduction in suicidality after only three days of hospitalization suggesting significant benefit from admission to a safe secure environment.

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Predictors of suicidal ideation trajectories in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study

Cited by 11 publications

References 29 publications

Persistence of suicidal ideation within acute phase treatment of major depressive disorder: analysis of clinical predictors

Persistence of suicidal ideation within acute phase treatment of major depressive disorder: analysis of clinical predictors

Clinical correlates and prognostic implications of severe suicidal ideation in major depressive disorder

Rapid reduction of nurse-rated suicidality among psychiatric patients shortly following hospitalization

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