Do risk factors for suicidal behavior differ by affective disorder polarity?

Fiedorowicz, Jess G.; Leon, Andrew C.; Keller, Martin B.; Solomon, David A.; Rice, John P.; Coryell, William

doi:10.1017/s0033291708004078

Cited by 40 publications

(45 citation statements)

References 53 publications

(48 reference statements)

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“…We included individuals with a prospectively derived diagnosis of unipolar MDD as described previously [32, 33]. These individuals had major depression at intake and did not develop mania or hypomania over follow-up [34, 35].…”

Section: Methodsmentioning

confidence: 99%

Seasonal variation of depressive symptoms in unipolar major depressive disorder

Cobb

Coryell

Cavanaugh

et al. 2014

Comprehensive Psychiatry

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Objectives Retrospective and cross-sectional studies of seasonal variation of depressive symptoms in unipolar major depression have yielded conflicting results. We examined seasonal variation of mood symptoms in a long-term prospective cohort – the Collaborative Depression Study (CDS). Methods The sample included 298 CDS participants from five academic centers with a prospectively derived diagnosis of unipolar major depression who were followed for at least ten years of annual or semi-annual assessments. Generalized linear mixed models were utilized to investigate the presence of seasonal patterns. In a subset of 271 participants followed for at least 20 years, the stability of a winter depressive pattern was assessed across the first two decades of follow-up. Results A small increase in proportion of time depressed was found in the months surrounding the winter solstice, although the greatest symptom burden was seen in December through April with a peak in March. The relative burden of winter depressive symptoms in the first decade demonstrated no relationship to that of the second decade. The onset of new episodes was highest October through January, peaking in January. Conclusions There exists a small but statistically significant peak in depressive symptoms from the month of the winter solstice to the month of the spring equinox. However, the predominance of winter depressive symptoms did not appear stable over the long-term course of illness.

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Section: Methodsmentioning

confidence: 99%

Seasonal variation of depressive symptoms in unipolar major depressive disorder

Cobb

Coryell

Cavanaugh

et al. 2014

Comprehensive Psychiatry

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“…The suicide completion was verified by autopsy report. To maximize statistical power, the clinically relevant outcomes of suicide attempts and completions were combined into a single variable, suicidal behavior, akin to prior studies [51][52][53] .…”

Section: Assessmentsmentioning

confidence: 99%

Suicidal Behavior in Prodromal Huntington Disease

Fiedorowicz

Mills²,

Ruggle³

et al. 2011

Neurodegener Dis

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Background: Several studies have suggested a greater risk of suicide in Huntington disease (HD); however, unique risk factors for suicide in HD are not established. Objective: We sought to determine risk factors for suicidal behavior, defined as suicide or attempted suicide, in prodromal HD. Methods: From the prospective PREDICT-HD cohort, we identified 735 cases with HD gene expansion but no manifest symptoms of HD and 194 non-gene-expanded controls. In survival analysis, a number of potential risk factors for suicidal behavior were assessed, including symptoms of depression, hopelessness, substance abuse, marital status, gender, and psychiatric history. Results: During a mean of 3.7 years of prospective follow-up, 12 cases (1.6%) attempted suicide and 1 completed suicide (0.1%). No suicides were observed among controls. In univariate Cox proportional hazards regression models, a history of suicide attempts (HR 8.5, 95% CI 2.8–26.1, p < 0.0002) and a Beck Depression Inventory II score >13 (HR 7.2, 95% CI 2.3–22.0, p < 0.0006) were associated with suicidal behavior. These risk factors had independent effects in multivariate models. A history of incarceration in the past 2 years was also associated (HR 12.5, 95% CI 2.7–56.6, p < 0.002), though uncommon. No further risk factors were identified. Conclusion: A history of suicide attempts and the presence of depression are strongly predictive of suicidal behavior in prodromal HD. As these risk factors are among the most robust risk factors for suicide, established suicide risk factors appear applicable to those with prodromal HD.

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“…To utilize the most accurate diagnosis, participants were assigned according to their prospectively detennined diagnosis rather than diagnosis at study intake. 6-11 …”

Section: Methodsmentioning

confidence: 99%

“…Prior analyses showed the prospective risk of suicidal behavior for these diagnoses to be similar, regardless of attempt severity. 6 …”

mentioning

confidence: 99%

Risk of Suicidal Behavior With Antidepressants in Bipolar and Unipolar Disorders

Leon¹,

Fiedorowicz²,

Solomon³

et al. 2014

J. Clin. Psychiatry

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Objective To examine the risk ofsuicidal behavior (suicide attempts and deaths) associated with antidepressants in participants with bipolar I, bipolar n, and unipolar major depressive disorders. Design A 27-year longitudinal (1981-2008) observational study ofmood disorders (Research Diagnostic Criteria diagnoses based on Schedule Dr Afi:ctive Disorders and Schizophrenia and review ofmedical records) was used to evaluate antidepressants and risk Dr suicidal behavior. Mixed-efi:cts logistic regression models examined propensity Dr antidepressant exposure. Mixed-efi:cts swvival models that were matched on the propensity score examined exposure status as a risk factor for time until suicidal behavior. Setting Five US academic medical centers. Results Analyses of206 participants with bipolar I disorder revealed 2,010 exposure intervals (980 exposed to antidepressants; 1,030 unexposed); 139 participants with bipolar II disorder had 1 ,407 exposure intervals (694 exposed; 713 unexposed); and 361 participants with unipolar depressive disorder had 2, 745 exposure intervals (1,328 exposed; 1,417 unexposed). Propensity score analyses confinned that more severely ill participants were more likely to initiate antidepressant treatment. In mixed-elects swvival analyses, those with bipolar I disorder had a significant reduction in risk of suicidal behavior by 54% (HR = 0.46; 95% CI, 0.31-0.69; t = -3.74; P < .001) during periods of antidepressant exposure compared to propensity-matched unexposed intervals. Similarly, the risk was reduced by 35% (HR = 0.65; 95% CI, 0.43-0.99; t = −2.01; P = .045) in bipolar II disorder. By contrast, there was no evidence of an increased or decreased risk with antidepressant exposure in unipolar disorder. Condusions Based on obsetVational data adjusted Dr propensity to receive antidepressants, antidepressants may protect patients with bipolar disorders but not unipolar depressive disorder from suicidal behavior.

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Do risk factors for suicidal behavior differ by affective disorder polarity?

Cited by 40 publications

References 53 publications

Seasonal variation of depressive symptoms in unipolar major depressive disorder

Seasonal variation of depressive symptoms in unipolar major depressive disorder

Suicidal Behavior in Prodromal Huntington Disease

Risk of Suicidal Behavior With Antidepressants in Bipolar and Unipolar Disorders

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