A multi-national study has identified the behavior patterns that precede many suicide attempts.
According to researchers, this could help lead to changes in the care of patients affected with depression.
According to the World Health Organization (WHO), more than 800,000 people commit suicide every year, with perhaps 20 times that number attempting suicide. Suicide is one of the leading causes of death in the young. For example, in the UK, it is the leading cause of death in men under the age of 35, according to WHO officials.
Those statistics fueled the international BRIDGE-II-MIX study looking at depression and suicide. The researchers evaluated 2,811 patients suffering from depression, including 628 who had already attempted suicide.
Each patient was interviewed by a psychiatrist as if it were a standard evaluation of a mentally ill patient. Parameters included previous suicide attempts, family history, current and previous treatment, patients’ clinical presentation, and how they scored on the standard Global Assessment of Functioning scale.
The researchers looked especially at the characteristics and behaviors of those who had attempted suicide, and compared these to depressed patients who had not attempted suicide.
What they found is that certain patterns are common before suicide attempts.
“We found that ‘depressive mixed states’ often preceded suicide attempts,” said Dr. Dina Popovic of the Hospital Clinic De Barcelona in Barcelona, Spain. “A depressive mixed state is where a patient is depressed, but also has symptoms of excitation, or mania.
“We found this significantly more in patients who had previously attempted suicide than those who had not. In fact, 40 percent of all the depressed patients who attempted suicide had a mixed episode rather than just depression. All the patients who suffer from mixed depression are at much higher risk of suicide.”
The researchers also found that the standard Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria identified only 12 percent of the patients showing mixed states.
“Our methods showed 40 percent of at-risk patients,” Popovic noted. “This means that the standard methods are missing a lot of patients at risk of suicide.”
In a second analysis of the figures, the researchers found that the risk of attempting suicide is 50 percent higher if a depressed patient presents any of the following symptoms:
- Risky behavior (e.g. reckless driving, promiscuous behavior);
- Psychomotor agitation (pacing around a room, wringing one’s hands, pulling off clothing, and putting it back on and other similar actions); or
- Impulsivity (acting on a whim, displaying behavior characterized by little or no forethought, reflection, or consideration of the consequences).
“In our opinion, assessing these symptoms in every depressed patient we see is extremely important, and has immense therapeutical implications,” Popovic said.
“Most of these symptoms will not be spontaneously referred by the patient. The clinician needs to inquire directly, and many clinicians may not be aware of the importance of looking at these symptoms before deciding to treat depressed patients.”
She added that this is an “important message for all clinicians — from the GPs who see depressed patients and may not pay enough attention to these symptoms, which are not always reported spontaneously by the patients, through to secondary and tertiary level clinicians. In highly specialized tertiary centers, clinicians working with bipolar patients are usually more aware of this, but that practice needs to extent to all levels.”
The strength of the study, according to Popovic, is “it’s not a clinical trial, with ideal patients — it’s a big study, from the real world.”