A “depressive mixed states” often precedes a suicide attempt.
A major study of 2,811 people suffering from depression has identified three behaviours that predict a suicide attempt.
The study compared depressed people who had attempted suicide with depressed people who had not.
The researchers found there were certain patterns of behaviour which increased the risk of a suicide attempt by 50%.
- Risky behaviour: this could be reckless sexual behaviour, dangerous driving or some other form of risky behaviour.
- Agitation: walking around the room, adjusting clothing, wringing one’s hands etc..
- Impulsivity: suddenly doing things without thinking about the consequences or planning.
Dr. Dina Popovic, one of the study’s authors, said:
“We found that “depressive mixed states” often preceded suicide attempts.
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% 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.
We also found that the standard DSM criteria identified 12% of patients at showing mixed states, whereas our methods showed 40% of at-risk patients.
This means that the standard methods are missing a lot of patients at risk of suicide.”
Dr. Popovic continued:
“In our opinion, assessing these symptoms in every depressed patient we see is extremely important, and has immense therapeutical implications.
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.
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 centres, clinicians working with bipolar patients are usually more aware of this, but that practice needs to extent to all levels.
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.”
The research was presented at the 28th ECNP Congress in Amsterdam (Popovic et al., 2015).