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Cited by 605Suicide and Self-Harm StudiesBipolar Disorder and TreatmentTreatment of Major Depression

Prospective study of clinical predictors of suicidal acts after a major depressive episode in patients with major depressive disorder or bipolar disorder

Oquendo, Maria A., Galfalvy, Hanga, Russo, Stefani, Ellis, Steven P., Grunebaum, Michael F., Burke, Ainsley, Mann, J. John·2004·American Journal of Psychiatry
DOI 10.1176/appi.ajp.161.8.1433
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Abstract

OBJECTIVE: The authors investigated the predictive potential of a stress-diathesis model for suicidal behavior based on correlates of past suicidal acts. In this model, suicidal acts are precipitated by stressors such as life events or a major depressive episode in the setting of a propensity for acting on suicidal urges. This diathesis is expressed as the tendency to develop more pessimism in response to a stressor and/or the presence of aggressive/impulsive traits. The predictive potential of the diathesis was tested by determining whether clinical correlates of past suicidal behavior predict suicidal acts during a 2-year follow-up of patients with a major depressive episode. METHOD: Patients with DSM-III-R major depressive disorder or bipolar disorder (N=308) were assessed at presentation for treatment of a major depressive episode. Potential predictors of suicidal acts in the 2 years after study enrollment were identified on the basis of an association with previous suicidal behavior and were tested by using Cox proportional hazards regression analysis. In addition, pessimism and aggression/impulsivity factors were generated, and their predictive ability was tested by using Cox proportional hazards regression analysis. RESULTS: The three most powerful predictors of future suicidal acts were a history of suicide attempt, subjective rating of the severity of depression, and cigarette smoking, each of which had an additive effect on future risk. The pessimism and aggression/impulsivity factors both predicted suicidal acts, and each factor showed an additive effect. CONCLUSIONS: In addition to obtaining a history of suicidal behavior, clinicians may find it useful to assess patients' current level of pessimism, aggressive/impulsive traits, and comorbidity with substance use disorders, including nicotine-related disorders, to help identify patients at risk for suicidal behavior after major depression. Interventions such as aggressive pharmacotherapeutic prophylaxis to prevent relapse or recurrence of depressive symptoms may protect such at-risk individuals from future suicidal behavior.

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Crossref · 10.1176/appi.ajp.161.8.1433

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  • Results of prospective studies on the effect of anxiety disorders on suicidal ideation are mixed, with some confirming and some falsifying the effect.

    “The role of anxiety in the development of SI is less clear, since results of prospective studies are mixed – some confirmed and some falsified the effect of anxiety disorders on SI (Abreu et al., 2018; Bolton et al., 2010; Oquendo et al., 2004).”

    From Modelling suicide ideation from beep to beep: application of network analysis to ecological momentary assessment data (2019) · cites this paper as Oquendo et al., 2004

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Authors
Oquendo, M. A., Galfalvy, H., Russo, S., Ellis, S. P., Grunebaum, M. F., Burke, A., & Mann, J. J.
Affiliations
New York State Psychiatric Institute (US)
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2004-08-01
Volume
161
Issue
8
Pages
1433-1441
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.161.8.1433
OpenAlex
W1976495499
Cited by
605
References
63
Citations by year
2026: 5 · 2025: 6 · 2024: 12 · 2023: 13 · 2022: 15 · 2021: 27 · 2020: 26 · 2019: 21 · 2018: 46 · 2017: 28 · 2016: 42 · 2015: 37 · 2014: 45 · 2013: 43 · 2012: 42
FWCI
25.16
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Funders
National Institute of Mental Health (R01MH048514, MH-62185-03, MH-48514-11, P50MH062185)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
suicidal behavior, suicide risk prediction, major depressive episode, major depressive disorder, bipolar disorder, diathesis-stress model, pessimism, suicide attempt history, depression severity, cigarette smoking, substance use comorbidity, relapse prevention
MeSH terms
Adult, Aggression, Bipolar Disorder, Depressive Disorder, Disease Susceptibility, Female, Follow-Up Studies, Humans, Impulsive Behavior, Life Change Events, Male, Personality Inventory, Prospective Studies, Psychiatric Status Rating Scales, Recurrence, Risk Factors, Severity of Illness Index, Smoking, Suicide, Suicide, Attempted, Proportional Hazards Models

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