TY - JOUR
T1 - Moderators of the association between depressive, manic, and mixed mood symptoms and suicidal ideation and behavior
T2 - An analysis of the National Network of Depression Centers Mood Outcomes Program
AU - Fiedorowicz, Jess G.
AU - Persons, Jane E.
AU - Assari, Shervin
AU - Ostacher, Michael J.
AU - Goes, Fernando S.
AU - Nurnberger, John I.
AU - Coryell, William H.
N1 - Funding Information:
JGF, JEP, SA, MJO, and WHC were involved in the conception and design of the analysis. JGF and JEP drafted the initial statistical analysis plan, which was then revised based on feedback by SA, MJO, and WHC and the NNDC grant review committee. JEP conducted all statistical analyses. JGF and JEP prepared the first draft of the manuscript. All authors critically reviewed the content of the manuscript and approved the final version for publication. The overall contributions JGP and JEP are considered equal. The National Network of Depression Centers (NNDC) provided feedback on the study design and provided access to the data. All authors are or have been at institutions affiliated with the network. This work was funded by a grant from the National Network of Depression Centers.
Funding Information:
This work was funded by a National Network of Depression Centers 2019 Momentum Grant. Jess Fiedorowicz received research support for a project with Myriad Genetics, Inc. Dr. Fiedorowicz was funded by the National Institute of Mental Health (R01MH111578) and Institute for Clinical and Translational Science at the University of Iowa (U54TR001356). Shervin Assari is funded through the National Institutes of Mental Health. Michael Ostacher is a full-time employee of the Department of Veterans Affairs, United States Government. He has had grants from National Institute on Drug Abuse (NIDA); personal fees from Alkermes, Janssen Pharmaceuticals (Johnson & Johnson), Sage Therapeutics, and grants from Otsuka Pharmaceutical and Palo Alto Health Sciences, outside the submitted work. Fernando Goes, John Nurnberger, and William Coryell have received research support from Janssen Pharmaceuticals. The authors have no other potential conflicts of interest to disclose.
Funding Information:
This work was funded by a grant from the National Network of Depression Centers.
Publisher Copyright:
© 2020
PY - 2021/2/15
Y1 - 2021/2/15
N2 - Background:: It has not been established that suicide risk with mixed symptoms is any greater than the depressive component or if there is synergy between depressive and manic symptoms in conveying suicide risk. Methods:: The National Network of Depression Centers Mood Outcomes Program collected data from measurement-based care for 17,179 visits from 6,105 unique individuals with clinically diagnosed mood disorders (998 bipolar disorder, 5,117 major depression). The Patient Health Questionaire-8 (PHQ-8) captured depressive symptoms and the Altman Self-Rating Mania scale (ASRM) measured hypomanic/manic symptoms. Generalized linear mixed models assessed associations between depressive symptoms, manic symptoms, and their interaction (to test for synergistic effects of mixed symptoms) on the primary outcome of suicidal ideation or behavior (secondarily suicidal behavior only) from the Columbia-Suicide Severity Rating Scale (C-SSRS). Moderation was assessed. Results:: PHQ-8 scores were strongly associated with suicide-related outcomes across diagnoses. ASRM scores showed no association with suicidal ideation/behavior in bipolar disorder and an inverse association in major depression. There was no evidence of synergy between depressive and manic symptoms. There was no moderation by sex, race, or mood disorder polarity. Those over 55 years of age showed a protective effect of manic symptoms, which was lost when depressive symptoms were also present (mixed symptoms). Discussion:: Mixed depressive and manic symptoms convey no excess risk of suicidal ideation or behavior beyond the risk conveyed by the depressive symptoms alone. Depressive symptoms are strongly linked to suicidal ideation and suicidal behavior and represent an important and potentially modifiable risk factor for suicide.
AB - Background:: It has not been established that suicide risk with mixed symptoms is any greater than the depressive component or if there is synergy between depressive and manic symptoms in conveying suicide risk. Methods:: The National Network of Depression Centers Mood Outcomes Program collected data from measurement-based care for 17,179 visits from 6,105 unique individuals with clinically diagnosed mood disorders (998 bipolar disorder, 5,117 major depression). The Patient Health Questionaire-8 (PHQ-8) captured depressive symptoms and the Altman Self-Rating Mania scale (ASRM) measured hypomanic/manic symptoms. Generalized linear mixed models assessed associations between depressive symptoms, manic symptoms, and their interaction (to test for synergistic effects of mixed symptoms) on the primary outcome of suicidal ideation or behavior (secondarily suicidal behavior only) from the Columbia-Suicide Severity Rating Scale (C-SSRS). Moderation was assessed. Results:: PHQ-8 scores were strongly associated with suicide-related outcomes across diagnoses. ASRM scores showed no association with suicidal ideation/behavior in bipolar disorder and an inverse association in major depression. There was no evidence of synergy between depressive and manic symptoms. There was no moderation by sex, race, or mood disorder polarity. Those over 55 years of age showed a protective effect of manic symptoms, which was lost when depressive symptoms were also present (mixed symptoms). Discussion:: Mixed depressive and manic symptoms convey no excess risk of suicidal ideation or behavior beyond the risk conveyed by the depressive symptoms alone. Depressive symptoms are strongly linked to suicidal ideation and suicidal behavior and represent an important and potentially modifiable risk factor for suicide.
KW - Attempted Suicide
KW - Bipolar disorder
KW - Depression
KW - Major Depressive Disorder
KW - Mania
KW - Mixed Symptoms
KW - Suicidal ideation
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U2 - 10.1016/j.jad.2020.11.101
DO - 10.1016/j.jad.2020.11.101
M3 - Article
C2 - 33234283
AN - SCOPUS:85096574985
VL - 281
SP - 623
EP - 630
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
SN - 0165-0327
ER -