RECHERCHE INTERNATIONALE Facteurs associés aux tentatives de suicide uniques ou multiples dans les troubles dépressifs

Research paper Factors Associated with Single versus Multiple Suicide Attempts in Depressive Disorders

Leonardo Tondo ^abc Ross J. Baldessarini ^ab Margherita Barbuti ^d Paola Colombini  ^d Jules Angst ^e Jean-Michel Azorin ^f Charles L.Bowden ^g Sergey Mosolov ^h Allan  H. Young ⁱ Eduard Vieta ^j Giulio Perugi ^d

^a International Consortium for Research on Mood & Psychotic Disorders, McLean Hospital, Belmont, Massachusetts, USA
 ^b Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
^c Lucio Bini Mood Disorders Centers, Cagliari & Rome, Italy
^d Department of Experimental and Clinical Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
^e Psychiatric Hospital, University of Zurich, Zurich, Switzerland
^f Department of Psychiatry, Hôpital Sainte Marguerite, University Hospitals of Marseille, Marseille, France
^g Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
^h Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
ⁱ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, London, UK
^j Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain

Received 21 April 2020, Revised 12 June 2020, Accepted 9 August 2020, Available online 14 August 2020.

https://www.sciencedirect.com/science/article/abs/pii/S0165032720326173

Highlights

Among depressed patients, women are more likely to attempt suicide multiple times.•

Intensive suicidal behaviour is associated with bipolar disorder and related features•

Repeated suicide attempts and mood-switching with ADs are frequently associated

Abstract

Background

Many risk factors for suicidal behavior have been identified. Much less has been done to associate risk factors with recurrence of suicidal behavior.

Methods

We compared prevalence of 30 potential risk factors among 8496 depressive patient-subjects from the BRIDGE consortium with no (NSA, n=6267), one (1SA, n=1123), or repeated (≥2) suicide attempts (RSA, n=1106).

Results

Prevalence of most factors ranked: RSA ≥ 1SA > NSA, with a notable opposite trend for the diagnosis of type II bipolar disorder (BD). Factors independently and significantly more present among RSA than 1SA subjects were: borderline personality, substance abuse, mood-switching with antidepressant treatment, female sex, and unsatisfactory response to antidepressant treatment. There also were notably strong associations of RSA with type I or probable BD and associated factors, including family history of BD, young onset, mixed and psychotic features.

Limitations

Potential effects of treatment on risk of suicidal acts could not be evaluated adequately, as well as associations between levels of suicidal behavior and eventual death by suicide.

Conclusions

In a large cohort of depressive patients, there were significant associations not only with suicidal behavior generally, but also with the intensity of suicide attempts.

Key words
Suicide attempts
Bipolar disorder
Depressive episode