Category: Bipolar Disorders
Background: Suicide is a leading cause of death in the United States, with over 800,000 taking their lives and more making attempts annually. Many studies have identified potential predictors of suicidal ideation (SI) and suicide attempts. However, SI tends to be unstable, and little is known about factors that impact the chronicity with which individuals report SI over time. It is unknown whether individuals with stable SI significantly differ from those with unstable SI. Identifying heterogeneity between these groups could suggest clinical differences that could predict future suicide risk and guide treatment decisions. We examined how differences in clinical variables could help to explain fluctuation in chronicity of SI over three months.
Methods: The present analyses used data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) outpatient clinical trial on individuals with bipolar depression. We examined consistency of reporting SI over the first three months of study participation. Patients were classified as consistent reporters of SI (N=42), inconsistent reporters of SI (N=348), and those with no reported SI during that period (N=1,982). Demographic and clinical variables upon entry to study were used to predict consistent/inconsistent/no SI using the Brown Forsythe modification of one way analysis of variance (ANOVA) and chi square tests of independence. Post-hoc t-tests were used to evaluate differences between consistent and inconsistent reporters of SI. Potential areas of focus were negative cognitions, in particular guilt, self-esteem and depressed mood, as well as baseline SI, previous suicide attempt history and suicide attempts over the course of the study.
Results: There were no significant differences between groups by age or gender (p>.05). There were overall group differences in baseline ratings of guilt, depressed mood, self-esteem, suicidal ideation, suicide attempt history, as well as attempts during study (p
Conclusion: This study presents potential clinical differences between consistent and inconsistent reporters of SI, specifically in baseline ratings of SI and guilt. However, the clinical significance of these findings is unclear due to the fact that suicide attempt history did not differentiate consistent and inconsistent reporters. Future research should discuss examining fluctuations in SI longitudinally as it may correspond to variability in other clinical variables, such as depressed mood or guilt.
Julia Yarrington– Post-Baccalaureate Fellow, National Institute of Mental Health, Bethesda
Elizabeth Ballard– Staff Scientist, National Institute of Mental Health
Lawrence Park– Staff Clinician, National Institute of Mental Health
Carlos Zarate Jr.– Branch Chief, National Institute of Mental Health
National Institute of Mental Health