Clinical and Sociodemographic Characteristics Associated with Suicidal Ideation in Depressed Outpatients

Abstract

Objective: To identify clinical and sociodemographic characteristics associated with suicidal ideation (SI) among patients seeking care for depression in routine primary and psychiatric care settings. Methods:We examined data from 4041 treatment-seeking outpatients with major depressive disorder (MDD) to compare baseline sociodemographic and clinical characteristics of those with and without SI, and the presence or absence of baseline depressive symptoms and psychiatric comorbidities in those with SI.Results: SI was significantly (P < 0.01) associated with numerous sociodemographic characteristics (that is, lower level of education, Caucasian or African American, male, unemployed, and treated in psychiatric care) and clinical features (that is, previous suicide attempt, younger age of MDD onset, greater baseline depressive symptom severity, greater number of depressive symptoms, and presence of agoraphobia and [or] generalized anxiety disorder). Elevated levels of SI at baseline were associated with decreased remission rates.Conclusions: Consistent with past findings, increased rates of SI were associated with greater depressive symptom severity as well as other features suggestive of severity of illness. Our results confirm previous findings of associations between SI and panic and (or) phobic symptoms and anxiety, but did not confirm previous findings of an association between SI and alcohol or drug use and (or) dependence. While selective serotonin reuptake inhibitor monotherapy appeared significantly helpful in reducing SI during the course of treatment, the presence of SI at baseline was found to be a associated with decreased treatment response, with patients reporting SI at the start of treatment being less likely to achieve remission.

Differential Associations of the Number of Comorbid Conditions and the Severity of Depression and Anxiety with Self-Reported Suicidal Ideation and Attempt in Major Depressive Disorder and Bipolar Disorder

“…between anxiety severity and current SR-SI in MDD ( Figure 2B1), but significant linear correlation in BPD ( Figure 2C1). The finding of positive correlation between depressive symptom severity and current SR-SI is consistent with previous studies in different populations [7,13,22,23,[32][33][34][35][36]. A stronger correlation between depressive severity and current SR-SI in BPD than in MDD in the present study supports previous findings that differences in suicidality may exist between patients with MDD and those with BPD [3,6,8,9].…”

Recurrent suicidal ideation in young adults

“…10 Recurrent SI co-occurring with psychiatric disorders might reflect the severity of the mental illness and be associated with greater impairment in multiple areas of functioning, including academic, employment, social and personal. 30 Additional factors associated with recurrent SI include higher life distress, anxiety, maternal depression, substance use and low levels of hope, social support and selfesteem. 7,8,10,11 Early detection, treatment and monitoring of substance use and psychological factors, including depression, may prevent SI recurrence, and have the potential to reduce the burden of suicidality in young people.…”

«Zero Suicide» – A model for reducing suicide in United States behavioral healthcare

“…Suicide rates in these settings are 100 times higher than those of the general population (Brown et al, 2000). At any time, ≈15 % of outpatient behavioral health patients endorsed suicidal ideation in the past week (Trivedi et al, 2013), 55 % report lifetime suicidal ideation, and more than 25 % made a suicide attempt (Harkavy-Friedman, 1993). These high rates are particularly alarming since outpatients experiencing suicidal ideation or a suicide attempt are more likely to eventually die by suicide (Wenzel et al, 2011).…”