Among the trajectories of clinical predictors of suicide attempt, depression symptoms were the only ones linked with an increased risk of suicide attempt in young adults whose parents have mood disorders, according to a longitudinal study.
Psychiatric diagnoses are well established as predictors of suicidal behavior; however, symptoms and risk can vary over the course of illness, and it is important to identify symptoms that can change over time, wrote Nadine M. Melhem, PhD, associate professor of psychiatry at the University of Pittsburgh, and her associates. The report is in JAMA Psychiatry.
Between July 15, 1997, and Sept. 6, 2005, 663 adolescents and young adults (mean age, 23.8 years) whose parents have mood disorders were recruited and followed until Jan. 21, 2014. All participants were assessed at baseline and every year for up to 12 years (median follow-up, 8.1 years) for lifetime and current psychiatric disorders as well as suicidal ideation. In addition, participants were assessed at baseline and at each follow-up for the trajectory of depression symptoms, hopelessness, impulsivity, aggression, impulsive aggression, and irritability.
After the study period, participants were analyzed for all trajectories and separated into classes based on mean scores and variability. All trajectories except for depression had two classes, in which participants in class 2 had higher mean scores and variability; for depression, patients were separated into three classes, in which class 3 had the highest mean score and variability.
Over the study period, 71 of the 663 patients attempted suicide (10.7%), with 51 patients attempting suicide for the first time. The mean number of attempts was 1.2, and the median time from the last assessment to the attempt was 45 weeks.
(22.9% with vs. 27 without), class 2 impulsivity (38.8% vs. 21.7%), class 2 aggression (29.0% vs. 15.6%), class 2 impulsive aggression (76.5% vs. 52.2%), and class 2 irritability (39.4% vs. 22.7%). However, after adjustment for demographics, parental suicide attempts, and additional clinical characteristics, only class 3 depression remained associated with suicide attempts (odds ratio, 4.72; 95% confidence interval, 1.47-15.21; P = .01).
Other significant predictors of suicide attempts were younger age (OR, 0.82; 95% CI, 0.74-0.90; P less than .001), lifetime history of unipolar disorder (OR, 4.71; 95% CI, 1.63-13.58; P = .004), lifetime history of bipolar disorder (OR, 3.4; 95% CI, 0.96-12.04; P = .06), history of childhood abuse (OR, 2.98; 95% CI, 1.40-6.38; P = .01), and parental suicide attempt (OR, 2.24; 95% CI, 1.06-4.75; P = .04).
The investigators concluded that clinicians should “pay particular attention to the severity of both current and past depression and the variability in these symptoms, and 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.”
Dr. Melhem reported receiving research support from the National Institute of Mental Health, the Brain and Behavior Research Foundation, and the American Foundation for Suicide Prevention. Several other coauthors also reported conflicts of interest.
SOURCE: Melhem NM et al. JAMA Psychiatry. 2019 Feb 27. doi: 10.1001/jamapsychiatry.2018.4513.