Association between irritability and suicidal ideation in three clinical trials of adults with major depressive disorder.
Manish K JhaAbu MinhajuddinCherise Chin FattKatharina KircanskiArgyris StringarisEllen LeibenluftMadhukar H TrivediPublished in: Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology (2020)
Irritability in pediatric samples is associated with higher rates of subsequent suicide-related outcomes. No study, to date, has evaluated the longitudinal association between irritability and suicidal ideation (SI) in adults with major depressive disorder (MDD). This report evaluated whether irritability is associated with SI at the same visit (i.e., concurrently) and whether early changes in irritability with antidepressant treatment predict subsequent levels of SI. Participants of Combining Medications to Enhance Depression Outcomes (CO-MED, n = 665), Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC, n = 296), and Suicide Assessment Methodology Study (SAMS, n = 266) were included. Repeated-measures mixed model analyses evaluated concurrent association throughout the trial between irritability (five-item irritability domain of Concise Associated Symptom Tracking scale) and SI (three-item suicidal thoughts factor of Concise Health Risk Tracking scale) after controlling for overall depression (excluding suicidality-related item), and predicted subsequent levels of SI (repeated observations from week-2-to-week-8) based on early (baseline-to-week-2) changes in irritability after controlling for early changes in overall depression. Higher irritability was associated with higher SI concurrently; estimates (standard error) were 0.18 (0.02, p < 0.0001), 0.64 (0.02, p < 0.0001), and 0.26 (0.04, p < 0.0001) in CO-MED, EMBARC, and SAMS respectively. Greater baseline-to-week-2 reductions in irritability predicted lower levels of subsequent SI; estimates (standard errors) were -0.08 (0.03, p = 0.023), -0.50 (0.05, p < 0.0001), and -0.12 (0.05, p = 0.024) in CO-MED, EMBARC, and SAMS, respectively. Controlling for anxiety or insomnia produced similar results. In conclusion, irritability and SI were consistently linked in adults with MDD. These findings support careful assessment of irritability in suicide risk assessment.
Keyphrases
- major depressive disorder
- bipolar disorder
- room temperature
- clinical trial
- risk assessment
- depressive symptoms
- sleep quality
- healthcare
- health risk
- palliative care
- type diabetes
- squamous cell carcinoma
- heavy metals
- radiation therapy
- randomized controlled trial
- phase ii
- insulin resistance
- metabolic syndrome
- emergency department
- study protocol
- physical activity
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- psychometric properties
- open label
- drug induced
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