Abstract
This chapter reviews the broad topic of suicide in patients with mood disorders. Suicide was the tenth most common cause of death in the United States in 2013 (Bostwick et al., Am J Psychiatry 173:11, 2016) and the leading cause of death in the 15–29 age group globally (Benard et al., L’Encephale 42:234–241, 2016). One of the risk factors for suicide is the presence of psychopathology, mostly mood disorders. Indeed, about ½–2/3 of all suicides occur in patients who suffer from mood disorders (Isometsa, Can J Psychiatry 59(3):120–130, 2014). Twenty five to 50% of patients with bipolar disorder (Latalova et al., Psychiatr Danub 26(2):108–114, 2014) and 30–40% of patients with major depressive disorder (MDD) have a positive lifetime history of attempted suicide (Isometsa, Can J Psychiatry 59(3):120–130, 2014; Popovic et al., Bipolar Disord 17:795–803, 2015). The percentage of patients completing suicide is estimated at 8–19% for bipolar disorder (Latalova et al., Psychiatr Danub 26(2):108–114, 2014) and up to 15% for MDD (Antypa et al., Eur Arch Psychiatry Clin Neurosci 266:181–193, 2016). Epidemiological data related to mood disorders and suicide are discussed. There are different etiological theories attempting to explain the phenomenon of suicide in mood disorders, which are reviewed in this chapter. Even though risk factors for suicide have been extensively studied, prediction of those at higher risk for death by suicide continues to be difficult (Mallick and McCullumsmith, Curr Psychiatry Rep 18:61, 2016). This chapter covers risk factors for suicide in mood disorders and implications for suicide risk assessment. Finally, the recommended interventions for suicide prevention and treatment are reviewed.
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Antypa N, Souery D, Tomasini M, Albani D, Fusco F, Mendlewicz J, Serretti A. Clinical and genetic factors associated with suicide in mood disorder patients. Eur Arch Psychiatry Clin Neurosci. 2016;266:181–93.
American Psychiatric Association (APA). Diagnosis and statistical manual of mental disorders. 5th ed. Arlington (VA): American Psychiatric Association; 2013.
Martiny K, Refsgaard E, Lund V, et al. Maintained superiority of chronotherapeutics vs. exercise in a 20-week randomized follow-up trial in major depression. Acta Psychiatr Scand. 2015;131(6):446–57.
Isometsa E. Suicidal behavior or mood disorders- who, when, and why? Can J Psychiatr. 2014;59(3):120–30.
Popovic D, Vieta E, Azorin J-M, Angst J, Bowden CL, Mosolov S, Young AH, Perugi G. Suicide attempts in major depressive episode: evidence from the BRIDGE-II-mix study. Bipolar Disord. 2015;17:795–803.
Tondo L, Baldessarini RJ. Suicidal behavior and mood disorders: response to pharmacological treatment. Curr Psychiatry Rep. 2016;18:88.
Latalova K, Kamaradova D, Prasko J. Suicide in bipolar disorder: a review. Psychiatr Danub. 2014;26(2):108–14.
Benard V, Vaiva D, Masson M, Geoffroy PA. Lithium and suicide prevention in bipolar disorder. L’Encephale. 2016;42:234–41.
Pavlova B, Perlis RH, Alda M, Uher R. Lifetime prevalence of anxiety disorders in people with bipolar disorder: a systematic review and meta-analysis. Lancet Psychiatry. 2015;2:710–7.
Schaffer A, Isometsa ET, Tondo L, et al. International society for bipolar disorders task force and suicide: meta-analyses and meta-regression of correlates of suicide attempts and suicide deaths in bipolar disorder. Bipolar Disord. 2014;17:1–16.
Grudet C, Malm J, Westrin A, Brundin L. Suicidal patients are deficient in vitamin D, associated with a pro-inflammatory status in the blood. Psychoneuroendocrinology. 2014;50:210–9.
O’Connor D, Ferguson E, Green JA, O’Carroll RE, O’Connor RC. Cortisol levels and suicidal behavior: a meta-analysis. Psychoneuroendocrinology. 2016;63:370–9.
O’Connor D, Green JA, Ferguson E, O’Carroll RE, O’Connor RC. Cortisol reactivity and suicidal behavior: investigating the role of hypothalamic-pituitary-adrenal axis responses to stress in suicide attempters and ideators. Psychoneuroendocrinology. 2017;75:183–91.
Kao WT, Yang MC, Lung FW. Association between HTR1B alleles and suicidal ideation in individuals with major depressive disorder. Neurosci Lett. 2017;638:204–10.
Al Jurdi RK, Swann A, Mathew SJ. Psychopharmacological agent and suicide risk reduction: ketamine and other approaches. Curr Psychiatry Rep. 2015;17:81.
Pawlak J, Dmitrzak-Weglarz M, Wilkosc M, Szczepankiewicz A, Leszczynska-Rodziewicz A, Zaremba D, Kapelski P, Rajewska-Rager A, Hauser J. Suicidal behavior as a quantitative trait and its genetic background. J Affect Disord. 2016;206:241–50.
Lopez-Castroman J, Courtent P, Baca-Garcia E, Oquendo MA. Identification of suicide risk in bipolar disorder. Bipolar Disord. 2015;17:22–3.
Saunders KEA, Hawton K. Suicidal behavior in bipolar disorder: understanding the role of affective states. Bipolar Disord. 2015;17:24–6.
Courtet P, Jaussent I, Genty C, Dupuy AM, Guillaume S, Ducasse D, Olie E. Increased CRP levels may be a trait marker of suicidal attempt. Eur Neuropsychopharmacol. 2015;25:1824–31.
Wilson S, Megan C, Fertuck E, Keilp J, Brodsky B, Mann JJ, Sonmez CC, Benjamin-Phillips C, Stanley B. Hear rate variability and suicidal behavior. Psychiatry Res. 2016;240:241–7.
Bernert RA, Luckenbaugh DA, Duncan WC, Iwata NG, Ballard ED, Zarate CA. Sleep architecture parameters as a putative biomarker of suicidal ideation in treatment-resistant depression. J Affect Disord. 2017;208:309–15.
Rihmer Z, Gonda X. Pharmacological prevention of suicide in patients with major mood disorders. Neurosci Biobehav Rev. 2013;37:2398–403.
Kay DB, Drombrovski AY, Buysse DJ, Reynolds CF III, Begley A, Szanto K. Insomnia is associated with suicide attempt in middle aged and older adults with depression. Int Psychogeriatr. 2016;28(4):613–9.
Mallick F, McCullumsmith CB. Ketamine for treatment of suicidal ideation and reduction of risk for suicidal behavior. Curr Psychiatry Rep. 2016;18:61.
Berutti M, Silva Dias R, Alver Pereira V, Lafer B. Association between history of suicide attempts and family functioning in bipolar disorder. J Affect Disord. 2016;192:28–33.
Owen R, Gooding P, Dempsey R, Jones S. A qualitative investigation into the relationships between social factors and suicidal thoughts and acts experienced by people with a bipolar disorder diagnosis. J Affect Disord. 2015;176:133–40.
Perez S, Marco JH, Garcia-Alandete J. Psychopathological differences between suicide ideators and suicide attempters in patients with mental disorders. Clin Psychol Psychother. 2017;24(4):1002–13.
Klonsky ED, Qiu T, Saffer BY. Recent advances in differentiating suicide attempters from suicide ideators. Curr Opin Psychiatry. 2017;30:15–20.
Aaltonen K, Naatanen P, Heikkinen M, Koivistro M, Baryshnikov I, Karpov B, Oksanen J, Melartin T, Suominen K, Joffe G, Paunio T, Isometsa E. Differences and similarities of risk factors for suicidal ideation and attempts among patients with depressive or bipolar disorders. J Affect Disord. 2016;193:318–30.
Zalpuri I, Rothschild AJ. Does psychosis increase her risk of suicide in patients with major depression? A systematic review. J Affect Disord. 2016;198:23–31.
Bostwick JM, Pabbati C, Geske J, McKean AJ. Suicide attempt as a risk factor for completed suicide: even more lethal than we knew. Am J Psychiatry. 2016;173:11.
Conejero I, Lopez-Castroman J, Giner L, Baca-Garcia E. Social demographic antecedent valley dangers of suicidal behavior: a review of recent literature. Curr Psychiatry Rep. 2016;13:94.
Schaffer A, Isometsa ET, Azorin JM, et al. A review of factors associated with greater likelihood of suicide attempts and suicide deaths in bipolar disorder: part II of her report of the International Society for Bipolar Disorders Task Force on suicide in bipolar disorder. Aust N Z J Psychiatry. 2015;49(11):1006–20.
Mertz DG, Kelleci M, Mizrak A, Semiz M, Demir MO. Factors associated with suicide attempts in patients with bipolar disorder type I. Psychiatr Danub. 2015;27(3):236–41.
Seo HJ, Wang HR, Jun TY, Woo YS, Bahk WM. Factors related to suicidal behavior in patients with bipolar disorder: the effect of mixed features on suicidality. Gen Hosp Psychiatry. 2016;38:91–6.
Cremaschi L, Dell’Osso B, Vismara M, Dobrea C, Buoli M, Ketter TA, Altamura C. Onset polarity in bipolar disorder: a strong association between first depressive episode and suicide attempts. J Affect Disord. 2017;209:182–7.
Carvalho AF, McIntyre RS, Dimelis D, Gonda X, Berk M, Nunes-Neto PR, Cha DS, Hyphantis TN, Angst J, Fountoulakis KN. Predominant polarity is of course specifier for bipolar disorder, and a systematic review. J Affect Disord. 2014;163:56–64.
Zimmerman M, Martinez J, Young D, Chelminski I, Morgan T, Dalrymple K. Comorbid bipolar disorder and borderline personality disorder and history of suicide attempts. J Personal Disord. 2014;28(3):358–64.
Werbeloff N, Markou M, Hayes JF, Pitman AL, Osborn DPJ. Individual and area-level risk factors for suicidal ideation and attempt in people with severe depression. J Affect Disord. 2016;205:387–92.
Wakefield JC, Schmitz MF. Feelings of worthlessness during a single complicated major depressive episode predict postremission suicide attempt. Acta Psychiatr Scand. 2016;133(4):257–65.
Baek JH, Heo JY, Fava M, Mischoulon D, Nierenberg A, Hong JP, Roh S, Jeon HJ. Anxiety symptoms are linked to new-onset suicidal ideation after 6 months of follow-up in outpatients with major depressive disorder. J Affect Disord. 2015;187:183–7.
Ramberg M, Stanley B, Ystgaard M, Mehlum L. Depressed suicide attempters with posttraumatic stress disorder. Arch Suicide Res. 2015;19:48–59.
Carter J, Arentsen TJ, Cordova J, Ruzek J, Reiser R, Suppes T, Ostacher MJ. Increased suicidal ideation in patients with co-Oecurring bipolar disorder and post-traumatic stress disorder. Arch Suicide Res. 2016;0:1–12.
Aas M, Henry C, Belliver F, Lajnef M, Gard S, Kahn JP, Lagerberg TV, Aminoff SR, Bjella T, Leboyer M, Andreassen OA, Melle I, Etain B. Affective lability mediates the association between childhood trauma and suicide attempts, mixed episodes and co-morbid anxiety disorders in bipolar disorders. Psychol Med. 2017;47(5):902–12.
Lan WH, Bai YM, Hsu JW, Huang KL, Su TP, Li CT, Yang AC, Lin WC, Chang WH, Chen TJ, Tsai SJ, Chen MH. Comorbidity of ADHD and suicide attempts among adolescents and young adults with bipolar disorder: a nationwide longitudinal study. J Affect Disord. 2015;176:171–5.
Carra G, Bartoli F, Crocamo C, Brady KT, Clerici M. Attempted suicide in people with co-occurring bipolar and substance use disorder: systematic review and meta-analysis. J Affect Disord. 2014;167:125–35.
Oquendo MA, Currier D, Liu SM, Hasin DS, Grant BF, Blanco C. Increased risk for suicidal behavior in comorbid bipolar disorder and alcohol use disorder: results from the National Epidemiologic Survey on alcohol and related conditions (NESARC). Clin Psychiatry. 2010;71:902–9.
Ballard ED, Vande Voort JL, Luckenbaugh DA, Machado-Vieira R, Tohen M, Zarate CA. Acute risk factors for suicide attempts and death: prospective findings from the STEP-BD study. Bipolar Disord. 2016;18:363–72.
Jylha P, Rosenstrom T, Mantere O, Suominen K, Melartin T, Vuorilehto M, Holma M, Riihimaki K, Oquendo MA, Keltikangas-Jarvinen L, Isometsa ET. Personality disorders and suicide attempts in unipolar and bipolar mood disorders. J Affect Disord. 2016;190:632–9.
Frias A, Baltasar I, Birmaher B. Comorbidity between bipolar disorder and borderline personality disorder: prevalence, explanatory theories, and clinical impact. J Affect Disord. 2016;202:210–9.
Hawkins M, Schaffer A, Reis C, Sinyor M, Herrmann N, Lanctot KL. Suicide in males and females with cardiovascular disease and comorbid depression. J Affect Disord. 2016;197:88–93.
Lam RW, McIntosh D, Wang JL, Enns MW, Kolivakis T, Michalak E, Sareen J, Song WY, Kennedy SH, MacQueen G, Milev RV, Parikh SV, Ravindran AV, the CANMAT Depression Work Group. Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the Management of Adults with major depressive disorder: section I. Disease burden and principles of care. Can J Psychiatr. 2016;61(9):510–23.
Stange JP, Kleiman EM, Sylvia LG, Vieira-da Silva P, Berk M, Nierenberg AA, Deckersbach T. Specific mood symptoms confer risk for subsequent suicidal ideation in bipolar disorder with and without suicide attempt history: multi-wave data from STEP-BD. Depress Anxiety. 2016;33:464–72.
Calvacante Passos I, Mwangi B, Cao B, Hamilton J, Wu MJ, Zhang XY, Zunta-Soares GB, Quevedo J, Kauer-Sant-Anna M, Kapczinski F, Soares J. Identifying a clinical signature of suicidality among patients with mood disorders: a pilot study using a machine learning approach. J Affect Disord. 2016;193:109–16.
Rudzinksi LA, Meadork JJ. Epilepsy: 5 new things. Neurology. 2011;76(7 Suppl 2) S20–S25.
Carnell BL, Clarke P, Gill S, Galletly CA. How effective is repetitive transcranial magnetic stimulation for bipolar depression? J Affect Disord. 2017;209:270–2.
George MS, Raman R, Benedek DM, et al. A two-site pilot randomized 3 day trial of high dose left prefrontal repetitive transcranial magnetic stimulation (rTMS) for suicidal inpatients. Brain Stimul. 2014;7:421–31.
Desmyter S, Duprat R, Baeken C, Bijttebier S, van Heeringen K. The acute effects of accelerated repetitive transcranial magnetic stimulation on suicide risk in unipolar depression: preliminary results. Psychiatr Danub. 2014;26(Suppl 1):48–52.
Sher L, Mindes J, Novakovic V. Transcranial magnetic stimulation and the treatment of suicidality. Expert Rev Neurother. 2010;10(12):1781–4.
Fink M, Kellner CH, Vaughn McCall W. The role of ECT in suicide prevention. J ECT. 2014;30:5–9.
Pflug B, Tolle R. Disturbance of the 24-hour rhythm in endogenous depression and the treatment of endogenous depression by sleep deprivation. Int Pharmacopsychiatry. 1971;6(3):187–96.
Nussbaumer B, Kaminski-Hartenthaler A, Forneris CA, et al. Light therapy for preventing seasonal affective disorder. Cochrane Database Syst Rev. 2015;11:CD011269.
Tuunainen A, Kripke DF, Endo T. Light therapy for non-seasonal depression. Cochrane Database Syst Rev. 2004;2:CD004050.
Al-Karawi D, Jubair L. Bright light therapy for nonseasonal depression: meta-analysis of clinical trials. J Affect Disord. 2016;198:64–71.
Benedetti F, Riccaboni R, Locatelli C, Poletti S, Dallaspezia S, Colombo C. Rapid treatment response of suicidal symptoms to lithium, sleep deprivation, and light therapy (chronotherapeutics) in drug-resistant bipolar depression. J Clin Psychiatry. 2014;75(2):133–40.
Martiny K, Refsgaard E, Lund V, et al. A 9-week randomized trial comparing a chronotherapeutic intervention (wake and light therapy) to exercise in major depressive disorder patients treated with duloxetine. J Clin Psychiatry. 2012;73(9):1234–42.
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Herrera, M. (2018). Mood Disorders and Suicide. In: Falcone, T., Timmons-Mitchell, J. (eds) Suicide Prevention. Springer, Cham. https://doi.org/10.1007/978-3-319-74391-2_2
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DOI: https://doi.org/10.1007/978-3-319-74391-2_2
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