Depressed people who display risky behaviour, agitation and impulsivity are at least 50 per cent more likely to attempt suicide, a major new study has found.
The study identified the behaviour patterns which precede many suicide attempts. This may lead to changes in clinical practice in the care of patients affected with depression, as it shows the clinical factors which confer major risk of suicide attempts, researchers said.
Researchers evaluated 2,811 patients suffering from depression, of whom 628 had already attempted suicide.
Each patient was interviewed by a psychiatrist as if it were a standard evaluation of a mentally-ill patient.
The study looked especially at the characteristics and behaviours of those who had attempted suicide, and compared these to depressed patients who had not attempted suicide.
They found that certain patterns recur before suicide attempts.
"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," said Dina Popovic, from the Hospital Clinic de Barcelona in Spain.
"In fact 40 per cent of all the depressed patients who attempted suicide had a "mixed episode" rather than just depression," said Popovic.
"All the patients who suffer from mixed depression are at much higher risk of suicide," said Popovic.
"We also found that the standard DSM criteria identified 12 per cent of patients at showing mixed states, whereas our methods showed 40 per cent of at-risk patients," said Popovic.
"This means that the standard methods are missing a lot of patients at risk of suicide," said Popovic.
In a second analysis of the figures, researchers found that if a depressed patient presented symptoms of risky behaviour (eg reckless driving, promiscuous behaviour), psychomotor agitation (pacing around a room, wringing one's hands, and other similar actions), or impulsivity (acting on a whim, displaying behaviour characterised by little or no reflection of the consequences), then their risk of attempting suicide is at least 50 per cent higher.
"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," said Popovic.
"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," said Popovic.
