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Chapter 7 - Mood Disorders and Suicide

Published online by Cambridge University Press:  16 May 2024

By
Rina Dutta  and
Joanna Hook
Edited by
Allan Young ,
Marsal Sanches ,
Jair C. Soares  and
Mario Juruena
Allan Young
Affiliation:
Institute of Psychiatry, King's College London
Marsal Sanches
Affiliation:
Baylor College of Medicine, Texas
Jair C. Soares
Affiliation:
McGovern Medical School, The University of Texas
Mario Juruena
Affiliation:
King's College London
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Summary

Among patients with mood disorders, suicidal thinking, planning, and acts are common, particularly during major depressive episodes or mixed episodes. In this chapter, the epidemiology and aetiology of suicidal behaviour in major depressive disorder and bipolar disorder are outlined, followed by the relevant risk factors, and risk assessment of suicide. Finally, the latest evidence on treatments is discussed from a pharmacological, psychological and physical perspective.

Keywords

major depressive disorderbipolar disordersuicideattempted suicideepidemiologyaetiologyrisk factorsassessmentpharmacologypsychologyelectroconvulsive therapy (ECT)transcranial magnetic stimulation (TMS)vagus nerve stimulation (VNS).
Type
Chapter
Information
Clinical Textbook of Mood Disorders , pp. 74 - 81
Publisher: Cambridge University Press
Print publication year: 2024

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References

World Health Organisation. Preventing suicide: a global imperative. 2014.Google Scholar
Isometsa, E. Suicidal behaviour in mood disorders – who, when, and why? Can J Psychiatry. 2014;59(3):120–30.CrossRefGoogle Scholar
Rytterstrom, P, Ovox, SM, Wardig, R, Hultsjo, S. Impact of suicide on health professionals in psychiatric care mental healthcare professionals’ perceptions of suicide during ongoing psychiatric care and its impacts on their continued care work. Int J Ment Health Nurs. 2020;29(5):982–91.CrossRefGoogle ScholarPubMed
Royal College of Psychiatrists. Self-harm and suicide in adults: final report of the Patient Safety Group. CR229. College Report. 2020.Google Scholar
Lewis, G, Hawton, K, Jones, P. Strategies for preventing suicide. Br J Psychiatry. 1997;171(4):351–4.CrossRefGoogle ScholarPubMed
Schaffer, A, Sinyor, M, Kurdyak, P, et al. Population-based analysis of health care contacts among suicide decedents: identifying opportunities for more targeted suicide prevention strategies. World Psychiatry. 2016;15(2):135–45.CrossRefGoogle ScholarPubMed
Bachmann, S. Epidemiology of suicide and the psychiatric perspective. Int J Environ Res Public Health. 2018;15(7]CrossRefGoogle ScholarPubMed
Phillips, MR. Rethinking the role of mental illness in suicide. Am J Psychiatry. 2010;167(7):731–3.CrossRefGoogle ScholarPubMed
Tondo, L, Pompili, M, Forte, A, Baldessarini, RJ. Suicide attempts in bipolar disorders: comprehensive review of 101 reports. Acta Psychiatr Scand. 2016;133(3):174–86.CrossRefGoogle ScholarPubMed
Baldessarini, RJ, Tondo, L. Suicidal risks in 12 DSM-5 psychiatric disorders. J Affect Disord. 2020;271:66–73.CrossRefGoogle ScholarPubMed
Francis, ER, Fonseca de Freitas, D, Colling, C, et al. Incidence of suicidality in people with depression over a 10-year period treated by a large UK mental health service provider. BJPsych Open. 2021;7(6):e223.CrossRefGoogle Scholar
Guze, SB, Robins, E. Suicide and primary affective disorders. Br J Psychiatry. 1970;117(539):437–8.CrossRefGoogle ScholarPubMed
Dutta, R, Murray, RM, Hotopf, M, et al. Reassessing the long-term risk of suicide after a first episode of psychosis. Arch Gen Psychiatry. 2010;67(12):1230–7.CrossRefGoogle ScholarPubMed
Nordentoft, M, Mortensen, PB, Pedersen, CB. Absolute risk of suicide after first hospital contact in mental disorder. Arch Gen Psychiatry. 2011;68(10):1058–64.CrossRefGoogle ScholarPubMed
Schaffer, A, Isometsa, ET, Tondo, L, et al. Epidemiology, neurobiology and pharmacological interventions related to suicide deaths and suicide attempts in bipolar disorder: part I of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder. Aust N Z J Psychiatry. 2015;49(9):785–802.CrossRefGoogle ScholarPubMed
Dong, M, Zeng, LN, Lu, L, et al. Prevalence of suicide attempt in individuals with major depressive disorder: a meta-analysis of observational surveys. Psychol Med. 2019;49(10):1691–704.CrossRefGoogle ScholarPubMed
Voracek, M, Loibl, LM. Genetics of suicide: a systematic review of twin studies. Wien Klin Wochenschr. 2007;119(15–16):463–75.CrossRefGoogle ScholarPubMed
Mann, JJ, Arango, VA, Avenevoli, S, et al. Candidate endophenotypes for genetic studies of suicidal behavior. Biol Psychiatry. 2009;65(7):556–63.CrossRefGoogle ScholarPubMed
Laje, G, Paddock, S, Manji, H, et al. Genetic markers of suicidal ideation emerging during citalopram treatment of major depression. Am J Psychiatry. 2007;164(10):1530–8.CrossRefGoogle ScholarPubMed
van Heeringen, K, Mann, JJ. The neurobiology of suicide. Lancet Psychiatry. 2014;1(1):63–72.CrossRefGoogle ScholarPubMed
Pandey, GN. Biological basis of suicide and suicidal behavior. Bipolar Disord. 2013;15(5):524–41.CrossRefGoogle ScholarPubMed
Belvederi Murri, M, Prestia, D, Mondelli, V, et al. The HPA axis in bipolar disorder: systematic review and meta-analysis. Psychoneuroendocrinology. 2016;63:327–42.CrossRefGoogle ScholarPubMed
O’Connor, DB, 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.CrossRefGoogle ScholarPubMed
Dumais, A, Lesage, AD, Alda, M, et al. Risk factors for suicide completion in major depression: a case-control study of impulsive and aggressive behaviors in men. Am J Psychiatry. 2005;162(11):2116–24.CrossRefGoogle ScholarPubMed
Swann, AC, Dougherty, DM, Pazzaglia, PJ, et al. Increased impulsivity associated with severity of suicide attempt history in patients with bipolar disorder. Am J Psychiatry. 2005;162(9):1680–7.CrossRefGoogle ScholarPubMed
Oyesanya, M, Lopez-Morinigo, J, Dutta, R. Systematic review of suicide in economic recession. World J Psychiatry. 2015;5(2):243–54.CrossRefGoogle ScholarPubMed
O’Connor, RC, Kirtley, OJ. The Integrated Motivational-Volitional Model of Suicidal Behaviour. Philos Trans R Soc Lond B Biol Sci. 2018;373:20170268.CrossRefGoogle ScholarPubMed
Cho, SE, Na, KS, Cho, SJ, Im, JS, Kang, SG. Geographical and temporal variations in the prevalence of mental disorders in suicide: systematic review and meta-analysis. J Affect Disord. 2016;190:704–13.CrossRefGoogle ScholarPubMed
Plans, L, Barrot, C, Nieto, E, et al. Association between completed suicide and bipolar disorder: a systematic review of the literature. J Affect Disord. 2019;242:111–22.CrossRefGoogle ScholarPubMed
Simon, GE, Hunkeler, E, Fireman, B, Lee, JY, Savarino, J. Risk of suicide attempt and suicide death in patients treated for bipolar disorder. Bipolar Disord. 2007;9(5):526–30.CrossRefGoogle ScholarPubMed
Dome, P, Rihmer, Z, Gonda, X. Suicide risk in bipolar disorder: a brief review. Medicina (Kaunas). 2019;55(8]Google ScholarPubMed
Bradvik, L. Suicide risk and mental disorders. Int J Environ Res Public Health. 2018;15(9]CrossRefGoogle ScholarPubMed
Holma, KM, Melartin, TK, Haukka, J, et al. Incidence and predictors of suicide attempts in DSM-IV major depressive disorder: a five-year prospective study. Am J Psychiatry. 2010;167(7):801–8.CrossRefGoogle ScholarPubMed
Dutta, R, Boydell, J, Kennedy, N, et al. Suicide and other causes of mortality in bipolar disorder: a longitudinal study. Psychol Med. 2007;37(6):839–47.CrossRefGoogle ScholarPubMed
Mishara, BL, Chagnon, F. Why mental illness is a risk factor for suicide: implications for suicide prevention. In O’Connor, RC, Pirkis, J, editors. The International Handbook of Suicide Prevention. 2nd ed. Hoboken: Wiley, 2016; 594–608.CrossRefGoogle Scholar
Lopez-Morinigo, JD, Ayesa-Arriola, R, Torres-Romano, B, et al. Risk assessment and suicide by patients with schizophrenia in secondary mental healthcare: a case-control study. BMJ Open. 2016;6(9):e011929.CrossRefGoogle ScholarPubMed
Mann, JJ, Currier, D, Stanley, B, et al. Can biological tests assist prediction of suicide in mood disorders? Int J Neuropsychopharmacol. 2006;9(4):465–74.CrossRefGoogle ScholarPubMed
Bittar, A, Velupillai, S, Downs, J, Sedgwick, R, Dutta, R. Reviewing a decade of research into suicide and related behaviour using the South London and Maudsley NHS Foundation Trust Clinical Record Interactive Search (CRIS) system. Front Psychiatry. 2020;11:553463.CrossRefGoogle ScholarPubMed
Velupillai, S, Hadlaczky, G, Baca-Garcia, E, et al. Risk assessment tools and data-driven approaches for predicting and preventing suicidal behavior. Front Psychiatry. 2019;10:36.CrossRefGoogle ScholarPubMed
Boudreaux, ED, Rundensteiner, E, Liu, F, et al. Applying machine learning approaches to suicide prediction using healthcare data: overview and future directions. Front Psychiatry. 2021;12:707916.CrossRefGoogle ScholarPubMed
Baldessarini, RJ, Tondo, L, Hennen, J. Treating the suicidal patient with bipolar disorder. Reducing suicide risk with lithium. Ann N Y Acad Sci. 2001;932:24–38; discussion 9–43.CrossRefGoogle ScholarPubMed
Smith, KA, Cipriani, A. Lithium and suicide in mood disorders: updated meta-review of the scientific literature. Bipolar Disord. 2017;19(7):575–86.CrossRefGoogle ScholarPubMed
Katz, IR, Rogers, MP, Lew, R, et al. Lithium treatment in the prevention of repeat suicide-related outcomes in veterans with major depression or bipolar disorder: a randomized clinical trial. JAMA Psychiatry. 2022;79(1):24–32.CrossRefGoogle ScholarPubMed
Rasmussen, KG. Lithium for post-electroconvulsive therapy depressive relapse prevention: a consideration of the evidence. J ECT. 2015;31(2):87–90.CrossRefGoogle ScholarPubMed
Brus, O, Cao, Y, Hammar, A, et al. Lithium for suicide and readmission prevention after electroconvulsive therapy for unipolar depression: population-based register study. BJPsych Open. 2019;5(3):e46.CrossRefGoogle ScholarPubMed
Malhi, GS, Bell, E, Boyce, P, et al. The 2020 mood disorders clinical practice guidelines: Translating evidence into practice with both style and substance. Aust N Z J Psychiatry. 2021;55(9):919–20.CrossRefGoogle Scholar
Memon, A, Rogers, I, Fitzsimmons, S, et al. Association between naturally occurring lithium in drinking water and suicide rates: systematic review and meta-analysis of ecological studies. Br J Psychiatry. 2020;217(6):667–78.CrossRefGoogle ScholarPubMed
Teicher, MH, Glod, C, Cole, JO. Emergence of intense suicidal preoccupation during fluoxetine treatment. Am J Psychiatry. 1990;147(2):207–10.Google ScholarPubMed
Lu, CY, Zhang, F, Lakoma, MD, et al. Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study. BMJ. 2014;348:g3596.CrossRefGoogle ScholarPubMed
Cipriani, A, Furukawa, TA, Salanti, G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018;391(10128):1357–66.CrossRefGoogle ScholarPubMed
Dodds, TJ. Prescribed benzodiazepines and suicide risk: a review of the literature. Prim Care Companion CNS Disord. 2017;19(2]CrossRefGoogle Scholar
Boggs, JM, Lindrooth, RC, Battaglia, C, et al. Association between suicide death and concordance with benzodiazepine treatment guidelines for anxiety and sleep disorders. Gen Hosp Psychiatry. 2020;62:21–7.CrossRefGoogle ScholarPubMed
Forte, A, Pompili, M, Imbastaro, B, et al. Effects on suicidal risk: comparison of clozapine to other newer medicines indicated to treat schizophrenia or bipolar disorder. J Psychopharmacol. 2021;35(9):1074–80.CrossRefGoogle ScholarPubMed
Wilkinson, T, Ballard, ED, Bloch, MH, et al. The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis. Am J Psychiatry. 2018;175(2):150–8.CrossRefGoogle ScholarPubMed
Kritzer, MD, Mischel, NA, Young, JR, et al. Ketamine for treatment of mood disorders and suicidality: a narrative review of recent progress. Ann Clin Psychiatry. 2022;34(1):33–43.Google ScholarPubMed
Mewton, L, Andrews, G. Cognitive behavioral therapy for suicidal behaviors: improving patient outcomes. Psychol Res Behav Manag. 2016;9:21–9.Google ScholarPubMed
Scott, J, Bentall, R, Kinderman, P, Morriss, R. Is cognitive behaviour therapy applicable to individuals diagnosed with bipolar depression or suboptimal mood stabilizer treatment: a secondary analysis of a large pragmatic effectiveness trial. Int J Bipolar Disord. 2022;10(1):13.CrossRefGoogle ScholarPubMed
D’Anci, KE, Uhl, S, Giradi, G, Martin, C. Treatments for the prevention and management of suicide: a systematic review. Ann Intern Med. 2019;171(5):334–42.Google ScholarPubMed
Goldstein, TR, Axelson, DA, Birmaher, B, Brent, DA. Dialectical behavior therapy for adolescents with bipolar disorder: a 1-year open trial. J Am Acad Child Adolesc Psychiatry. 2007;46(7):820–30.CrossRefGoogle ScholarPubMed
Kellner, CH, Fink, M, Knapp, R, et al. Relief of expressed suicidal intent by ECT: a consortium for research in ECT study. Am J Psychiatry. 2005;162(5):977–82.CrossRefGoogle Scholar
Bozzay, ML, Primack, J, Barredo, J, Philip, NS. Transcranial magnetic stimulation to reduce suicidality – a review and naturalistic outcomes. J Psychiatr Res. 2020;125:106–12.CrossRefGoogle ScholarPubMed
Olin, B, Jayewardene, AK, Bunker, M, Moreno, F. Mortality and suicide risk in treatment-resistant depression: an observational study of the long-term impact of intervention. PLoS One. 2012;7(10):e48002.CrossRefGoogle ScholarPubMed

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