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The ability to predict suicidal behavior in psychiatric patients is one of the most challenging and high-stakes aspects of clinical practice. However, psychiatric diagnoses are of limited value for prediction because the risk for suicidal behavior can vary substantially over the course of a psychiatric illness. Researchers including University of Pittsburgh Department of Psychiatry investigators Nadine Melhem, PhD, and David Brent, MD, identified and studied multiple symptoms that vary over time—impulsivity, aggression, impulsive aggression, depression symptoms, irritability and hopelessness—to build a more successful prediction model.

In a longitudinal study of 663 offspring of 318 parents with mood disorders, the team investigated whether changes in these symptoms predict suicide attempts better than traditional predictors such as psychiatric diagnoses. Participants (parents and offspring) were recruited between 1997 and 2005 and were followed through January 2014. Participant interviews occurred at the baseline and at subsequent annual follow-ups over 12 years. 

Data collected during this period allowed the researchers to identify participants with severe symptom trajectories that exhibited variability over time. Of all symptoms studied, they found that severe and variable depression symptoms was the only statistically significant trajectory that predicted increased risk for suicidal behavior above and beyond psychiatric disorders. Furthermore, the research showed that in addition to severity and variability in depression symptoms, several key factors were also significant predictors: younger age (30 years old or younger), mood disorder, history of childhood abuse, history of suicide attempt and a parent’s suicide attempt. The research team used these key factors to compute and then evaluate a prediction risk score, which was found to more successfully predict suicide attempt than existing models. 

Dr. Melhem commented on the results of the study, which were recently published in JAMA Psychiatry: “Our findings suggest that when treating patients, clinicians must pay particular attention to the severity of current and past depressive symptoms and try to reduce their severity and fluctuations to decrease risk for suicidal behavior. Our Prediction Risk Score is a valuable addition to the physician's toolkit to help predict risk for suicidal behavior in high-risk individuals, and it can be done at little cost because the information needed is already being collected as part of standard evaluations.”

Severity and Variability of Depression Symptoms Predicting Suicide Attempt in High-Risk Individuals
Melhem NM, Porta G, Oquendo MA, Zelazny J, Keilp JG, Iynegar S, Burke A, Birmaher B, Stanley B, Mann JJ, Brent DA
JAMA Psychiatry. Published online February 27, 2019. doi:10.1001/jamapsychiatry.2018.4513