@article{2bb7916f9749433ea8597d910ec4400d,
title = "Bipolar depression and suicidal ideation: Moderators and mediators of a complex relationship",
abstract = "Introduction: Not all patients with bipolar depression have suicidal ideation (SI). This study examines some factors that link bipolar depression to SI. Methods: 482 individuals with bipolar I or II were randomized to either lithium or quetiapine plus adjunctive personalized therapy in a 24 week comparative effectiveness trial. Severity of depression and SI were assessed with the Bipolar Inventory of Symptoms Scale (BISS). We examined potential moderators (age, gender, age of illness onset, bipolar type, comorbid anxiety, substance use, past suicide attempts, childhood abuse and treatment arm) and mediators (severity of anxiety, mania, irritability, impairment in functioning (LIFE-RIFT) and satisfaction and enjoyment of life (Q-LES-Q)) of the effect of depression on SI. Statistical analyses were conducted using generalized estimating equations with repeated measures. Results: Bipolar type and past suicide attempts moderated the effect of depression on SI. Life satisfaction mediated the effect of depression and SI. The relationship between anxiety, depression and SI was complex due to the high level of correlation. Treatment with lithium or quetiapine did not moderate the effect of depression on SI. Limitations: Suicide assessment was only done using an item on BISS. Patient population was not specifically chosen for high suicide risk. Discussion: Individuals with Bipolar II experienced more SI with lower levels of depression severity. A history of suicide predisposed patients to higher levels of SI given the same severity of depression. Reduced life satisfaction mediates the effect of depression on SI and may be a target for therapeutic interventions.",
keywords = "Bipolar disorder, Depression, Lithium, Quetiapine, Suicidal ideation",
author = "Masoud Kamali and Reilly-Harrington, {Noreen A.} and Chang, {Weilynn C.} and Melvin McInnis and McElroy, {Susan L.} and Ketter, {Terence A.} and Shelton, {Richard C.} and Thilo Deckersbach and Mauricio Tohen and Kocsis, {James H.} and Calabrese, {Joseph R.} and Keming Gao and Thase, {Michael E.} and Bowden, {Charles L.} and Gustavo Kinrys and Bobo, {William V.} and Brody, {Benjamin D.} and Sylvia, {Louisa G.} and Rabideau, {Dustin J.} and Nierenberg, {Andrew A.}",
note = "Funding Information: Keming Gao, MD reports grants from Agency for Healthcare Research and Quality, during the conduct of the study; personal fees from Sunovion, personal fees from Otsuka, grants from Cleveland Foundation, grants from Brian and Behavior Research Foundation, outside the submitted work. Funding Information: Susan L. McElroy, MD reports grants from Agency for Healthcare Research and Quality, during the conduct of the study; personal fees from Bracket, personal fees from F. Hoffmann-La Roche Ltd., personal fees from MedAvante, personal fees from Mitsubishi Tanabe Pharma America, grants and personal fees from Myriad, grants and personal fees from Novo Nordisk, grants and personal fees from Shire, grants and personal fees from Sunovion, grants from Allergan, grants from Brainsway, grants from Marriott Foundation, outside the submitted work. Funding Information: Michael E. Thase, MD reports grants and personal fees from Alkermes, personal fees from AstraZeneca, personal fees from Bristol-Myers Squibb Company, grants and personal fees from Eli Lilly & Co, grants and personal fees from Forest Laboratories, personal fees from Gerson Lehman Group, personal fees from GlaxoSmithKline, personal fees from Guidepoint Global, personal fees from H. Lundbeck A/S, personal fees from MedAvante, personal fees from Merck and Co., personal fees from Neuronetics, Inc., personal fees from Ortho-McNeil Pharmaceuticals, grants and personal fees from Otsuka, personal fees from Pfizer, personal fees from Roche, personal fees from Shire US, Inc., personal fees from Sunovion Pharmaceuticals, Inc., personal fees from Takeda, other from American Psychiatric Foundation, other from Guilford Publications, other from Herald House, other from W.W. Norton & Company, Inc., other from Peloton Advantage, personal fees from Cerecor, Inc., personal fees from Moksha8, personal fees from Pamlab L.L.C. (Nestle), personal fees from Allergan, personal fees from Trius Therapeutical, Inc., personal fees from Fabre-Kramer Pharmaceuticals, Inc., grants from Agency for Healthcare Research and Quality, grants from AssureRx, grants from Avanir, grants from Forest Pharmaceuticals, grants from Janssen, grants from Intracellular, grants from National Institutes of Health, grants from Takeda, outside the submitted work. Funding Information: This work was supported by the Agency for Healthcare Research and Quality (AHRQ: 1R01HS019371) and the Dauten Family Center for Bipolar Treatment Innovation. Funding Information: Louisa G. Sylvia, PhD reports grants from Agency for Healthcare Research and Quality, during the conduct of the study; personal fees from Concordant Rater Systems, personal fees from United Biosource Corporation, personal fees from Clintara, personal fees from Bracket, personal fees from Clinical Trials Network and Institute, personal fees from New Harbinger, outside the submitted work; and she has also received grant/research support from NIMH, PCORI, AFSP, and Takeda. Publisher Copyright: {\textcopyright} 2019",
year = "2019",
month = dec,
day = "1",
doi = "10.1016/j.jad.2019.08.032",
language = "English (US)",
volume = "259",
pages = "164--172",
journal = "Journal of Affective Disorders",
issn = "0165-0327",
publisher = "Elsevier",
}