Prospective Study of Clinical Predictors of Suicidal Acts After a Major Depressive Episode in Patients With Major Depressive Disorder or Bipolar Disorder

Oquendo, María A.; Galfalvy, Hanga; Russo, Stefani A.; Ellis, Steven P.; Grunebaum, Michael F.; Burke, Ainsley K.; Mann, J. John

doi:10.1176/appi.ajp.161.8.1433

Cited by 525 publications

(442 citation statements)

References 63 publications

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“…These data suggest that our participants' distribution of executive-function performances overlaps to some extent with that of the healthy individuals on whom these tests were normed. Consistent with previous research, 20,21 impairment in inhibition may be a specific risk factor for suicidal ideation and behavior.…”

Section: Discussionsupporting

confidence: 89%

Differential Effects of Executive Functioning on Suicide Attempts

Burton¹,

Vella²,

Weller³

et al. 2011

Journal of Neuropsychiatry

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Suicide is common among individuals with psychiatric illness; executive functioning may be associated with suicide risk. The authors examined demographic, clinical, and executive-functioning variables in suicide ideators and suicide attempters, hypothesizing that attempters would demonstrate poorer executive-functioning skills. Seventy-seven participants with psychiatric illness completed a neuropsychological battery while hospitalized or residing in crisis-houses after expressing suicidal ideation (N=40) or making a suicide attempt (N=37). Logistic regression predicted suicide Ideator versus suicide Attempter status; suicide Attempters exhibited poorer inhibition but better problem-solving ability than suicide Ideators. Suicide attempt risk may be associated with better problem-solving skills, but worse inhibitory control.

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Section: Discussionsupporting

confidence: 89%

Differential Effects of Executive Functioning on Suicide Attempts

Burton¹,

Vella²,

Weller³

et al. 2011

Journal of Neuropsychiatry

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“…The relatively low base rate of suicidal behavior is a challenge for clinical trials and forces a focus on proxy outcomes with higher base rates such as suicidal ideation. Clinicians assess suicidal ideation in part to evaluate need for hospitalization because of its predictive validity for risk of suicide attempts (Oquendo et al, 2004a) and suicide (Fawcett et al, 1990;Beck et al, 1999). Depression appears to predict suicide attempts via its effect on suicidal ideation (Nock et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

“…Suicide attempt history and ideation severity are risk factors for suicide (Meyer et al, 2010). Prospective studies show that suicidal ideation increases the risk of attempts and suicide in mood disorders (Oquendo et al, 2004a;Fawcett et al, 1990). Within 1 year of ideation onset, 90% of unplanned and 60% of planned first suicide attempts occur (Kessler et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

Pilot Randomized Clinical Trial of an SSRI vs Bupropion: Effects on Suicidal Behavior, Ideation, and Mood in Major Depression

Grunebaum

Ellis

Duan

et al. 2011

Neuropsychopharmacol

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Randomized controlled trials in depressed patients selected for elevated suicidal risk are rare. The resultant lack of data leaves uncertainty about treatment in this population. This study compared a serotonin reuptake inhibitor with a noradrenergic/dopaminergic antidepressant in major depression with elevated suicidal risk factors. We conducted a double-blind, randomized, clinical pilot trial of paroxetine (N ¼ 36) or bupropion (N ¼ 38) in DSM IV major depression with a suicide attempt history or current suicidal ideation. The effects during acute (8 weeks) and continuation treatment (up to 16 weeks) were measured. Main outcomes were suicidal behavior and ideation. The secondary outcome was modified 17-item Hamilton Depression Rating Scale score subtracting the suicide item (mHDRS-17). Treatment was not associated with time to a suicidal event and no treatment main effect or treatment Â time interaction on suicidal ideation or mHDRS-17 was found. Exploratory model selection showed modest advantages for paroxetine on: (1) mHDRS-17 (p ¼ 0.02); and (2) in a separate model adjusted for baseline depression, for suicidal ideation measured with the Beck Scale for Suicidal Ideation (p ¼ 0.03), with benefit increasing with baseline severity. Depressed patients with greater baseline suicidal ideation treated with paroxetine compared with bupropion appeared to experience greater acute improvement in suicidal ideation, after adjusting for global depression. Given the lack of evidence-based pharmacotherapy guidelines for suicidal, depressed patientsFan important public health populationFthis preliminary finding merits further study.

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“…Few exceptions are the studies realized by Brown et al and Oquendo et al showing respectively that total score at SSI, BDI or HAM-D17 were risk factors for suicide in psychiatry outpatients (Brown et al, 2000) and that among other factors history of suicide attempt and subjective rating of the severity of depression predicted suicidal acts with an additive effect (Oquendo et al, 2004).…”

Section: Tablementioning

confidence: 95%

“…However, although a vast literature on correlates and risk factors for suicidal acts exists, prospective studies failed to predict even one suicide (Goldstein et al, 1991), with a few exceptions for two long term prospective studies (Brown et al, 2000;Oquendo et al, 2004). There might be several causes for this.…”

Section: Introductionmentioning

confidence: 99%

Is it valid to measure suicidal ideation by depression rating scales?

Desseilles

Perroud

Guillaume

et al. 2012

Journal of Affective Disorders

174

119

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Objective: To date, most researchers rely on suicidal items of scales primarily designed to measure depression severity to capture suicidal ideation (SI). This study aims at investigating how well the suicide item of the clinician rated Hamilton Scale for Depression (HAM-D) and principal factors derived from this scale correlate with SI scores derived from a well validated measure of SI: the Beck's scale for SI (SSI). Method: 281 suicide attempters consecutively hospitalized between 2007 and 2009 were assessed by using the SSI, the HAM-D and the self-report Beck Depression Inventory (BDI). Principal Component Analysis (PCA) was computed to extract main factors. Correlations between these factors, BDI's and HAM-D's suicide items and the SSI scores were then computed. Results: Three components were derived from the PCA. Factor 2 showed a major loading for the HAM-D suicide item. Both the HAM-D suicide item and Factor 2 positively correlated with the SSI total score (both p b 0.00001). Moreover, the BDI suicide item highly correlated with the Factor 2 (p b 0.001) and the SSI total score (p b 0.00001). Finally, the HAM-D suicide item correlated significantly with the number of suicide attempts (p = 0.0001) and the age at the first attempt (p = 0.002). Limitations: Our sample was heterogeneous and future studies should refine the taxonomy of the suicidal behavior in specific sub-populations. The study design was cross-sectional and replication in a prospective study is needed. Conclusion: These findings suggest that the use of a single suicide item or a dimensional factor derived from a depression scale might be a valid approach to assess the suicidal ideations. Moreover, the results suggest that clinician rated scales as well as self-report questionnaires are equally valid to do so.

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Prospective Study of Clinical Predictors of Suicidal Acts After a Major Depressive Episode in Patients With Major Depressive Disorder or Bipolar Disorder

Cited by 525 publications

References 63 publications

Differential Effects of Executive Functioning on Suicide Attempts

Differential Effects of Executive Functioning on Suicide Attempts

Pilot Randomized Clinical Trial of an SSRI vs Bupropion: Effects on Suicidal Behavior, Ideation, and Mood in Major Depression

Is it valid to measure suicidal ideation by depression rating scales?

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