A multi-national team of researchers has identified specific behaviors that precede many suicide attempts. The study, presented Aug. 30 at the 28th European College of Neuropsychopharmacology Congress (ECNP) in Amsterdam, found that risky behaviors, agitation and impulsivity occur before 50 percent of suicide attempts.
According to the World Health Organization (WHO), more than 800,000 people commit suicide every year, with perhaps another 20 times that number attempting suicide. In the U.S., suicide is the 10th leading cause of death, and American men are four times more likely than women to kill themselves.
The new international study involved investigators from the U.S., Spain, France, Switzerland, Russia, Italy and the U.K. The research team evaluated 2,811 patients suffering from depression, 628 of whom had previously attempted suicide.
Each patient in the study was evaluated by a psychiatrist as researchers looked for behavioral differences in those who had attempted suicide and those who had not. The researchers also looked at family history, current and previous treatments and how the participants scored on a standard functioning scale.
“The strength of this study is that it’s not a clinical trial with ideal patients – it’s a big study from the real world,” lead author Dina Popovic, MD, PhD, a psychiatrist at Barcelona Hospital Clinic and the Clinical Research Institute of Biomedical Research in Spain, said in an ECNP news release.
The researchers found that the risk of a suicide attempt was at least 50 percent higher if depressed patients engaged in risky behaviors such as reckless driving or promiscuity; if they exhibited psychomotor agitation, including pacing around the room or wringing their hands; or if they were impulsive, showing little or no forethought before acting or consideration of the consequences of their actions.
In addition, Popovic and her colleagues found “depressive mixed states” frequently preceded suicide attempts. In a depressive mixed state, depression is accompanied by symptoms of excitation or mania.
“We found this significantly more in patients who had previously attempted suicide, than those who had not,” said Popovic. “In fact, 40 percent of all the depressed patients who had attempted suicide had a ‘mixed episode’ rather than just depression.”
The team concluded that all patients who suffer from mixed depression are at a much higher risk of suicide. However, the researchers reported that the standard test for diagnosing depression only found 12 percent with mixed depression. In contrast, using new criteria, they were able to identify 40 percent of these patients.
“The major diagnostic and statistical manual that tells you what to do and how to diagnose patients is not paying attention to some of these symptoms,” Popovic told The Independent.
Compounding the issue of diagnosis is the fact that most of the symptoms of mixed depression are not reported by the patient themselves. This is of major concern because some clinicians may be unaware of mixed depression and not realize the risk of suicide.
“In our opinion, assessing these symptoms in every depressed patient we see is extremely important, and has immense therapeutical implications. 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,” Popovic said in the news release.
The important take-away message from the study, said the authors, is that healthcare professionals who see these patients need to pay more attention to mixed depression symptoms. Early identification of the symptoms and timely treatment of mixed depressive states, they noted, could represent a major step forward in suicide prevention.