Severity, Fluctuation of Depressive Symptoms Linked to Suicide Attempts in High-Risk Patients

The trajectory of depressive symptoms with the greatest mean scores and fluctuation over time predicted suicide attempt in high-risk individuals, according to study results published in JAMA Psychiatry.

Researchers conducted a longitudinal study of 663 offspring of 318 parents with a history of a mood disorder. Study participants were enrolled from the Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania and New York State Psychiatric Institute in New York City from 1997 to 2005, and followed annually until 2014. The team evaluated past and current psychiatric disorders using various self-reported questionnaires. The definition of suicide attempt incorporated actual, aborted, and interrupted attempts in addition to suicidal ideations that resulted in an emergency referral.

After analysis, the researchers found that the trajectory of depressive symptoms with the greatest mean scores and fluctuation over time predicted suicide attempt in the offspring (odds ratio [OR], 4.72; 95% CI, 1.47-15.21; P =.01). In addition, the team also detected other predictors that clinicians already evaluate during standard psychiatric assessments such as lifetime history of unipolar disorder and bipolar disorder (OR, 4.71; 95% CI, 1.63-13.58; P =.004 and OR, 3.4; 95% CI, 0.96-12.04; P =.06, respectively), younger age (OR, 0.82; 95% CI, 0.74-0.90; P <.001), history of childhood abuse (OR, 2.98; 95% CI, 1.40-6.38; P =.01), and parental actual attempt (OR, 2.24; 95% CI, 1.06-4.75; P =.04).

Researchers acknowledged that participation in the study and the application of safety protocols may have reduced suicidal events in the offspring in the sample, therefore influencing the results.

“We recommend that clinicians, in their assessment of depression, (1) pay particular attention to the severity of both current and past depression and the variability in these symptoms, and (2) monitor and treat depression symptoms over time to reduce symptom severity and fluctuation, and thus the likelihood for suicide attempt, in high-risk young adults,” they concluded.

Reference

Melhem NM, Porta G, Oquendo MA, et al. Severity and variability of depression symptoms predicting suicide attempt in high-risk individuals [published online February 27, 2019]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2018.4513