In search of clinical targets for suicide prevention in major depressive disorder

Neurological, Metabolic, and Psychopathological Correlates of Lifetime Suicidal Behaviour in Major Depressive Disorder without Current Suicide Ideation

“…We hypothesise that the excess of non-fatal SB reported in our older patients may be largely due to depressive disorders that began in young adulthood: in fact, the mean age of onset for those who had attempted suicide was 25 years, compared to 45 years for those who had not attempted suicide. As suicide attempts can occur even when SI is not reported, it is a priority for clinicians to investigate other predictors of SB; knowledge of these could facilitate the identification of individuals at increased risk of suicide and factors that lead them to attempt suicide, which could become targets for suicide prevention [12]. By analysing adult patients, our study identified four potential risk factors for SB in the absence of SI.…”

“…As the feasibility and effectiveness of combining these potential suicide predictors remain unclear, future research should consider prospective approaches and more sophisticated methods, such as machine learning, which may improve the accuracy of suicide screening [128]. At clinical level, not only established factors such as suicide ideation, anhedonia, and hopelessness [12] but also self-perception and psychological reactions to childhood abuse and maltreatment should be included among priority targets of intervention to reduce suicide risk in MDD.…”

“…On the other hand, the usefulness of assessing SI is limited by the finding that approximately 50% of subjects with SI and 30% of attempters do not disclose their thoughts [10]. In particular, the rate of SI denial is higher in serious attempters [11], who may deliberately conceal their intention to die to avoid interference [12]. The intensity of SI is characterised by rapid fluctuations over time [13], so that individuals who are not suicidal at the time of assessment may develop severe SI within a few hours [12].…”

“…In particular, the rate of SI denial is higher in serious attempters [11], who may deliberately conceal their intention to die to avoid interference [12]. The intensity of SI is characterised by rapid fluctuations over time [13], so that individuals who are not suicidal at the time of assessment may develop severe SI within a few hours [12]. This sudden increase could lead to an impulsive suicide attempt [14,15].…”