Bipolar depression and suicidal ideation: Moderators and mediators of a complex relationship

Masoud Kamali, Noreen A. Reilly-Harrington, Weilynn C. Chang, Melvin McInnis, Susan L. McElroy, Terence A. Ketter, Richard C. Shelton, Thilo Deckersbach, Mauricio Tohen, James H. Kocsis, Joseph R. Calabrese, Keming Gao, Michael E. Thase, Charles L. Bowden, Gustavo Kinrys, William V Bobo, Benjamin D. Brody, Louisa G. Sylvia, Dustin J. Rabideau, Andrew A. Nierenberg

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)164-172
Number of pages9
JournalJournal of Affective Disorders
Volume259
DOIs
StatePublished - Dec 1 2019

Fingerprint

Mediator Complex
Suicidal Ideation
Bipolar Disorder
Depression
Suicide
Anxiety
Lithium
Equipment and Supplies
Therapeutics
Age of Onset

Keywords

  • Bipolar disorder
  • Depression
  • Lithium
  • Quetiapine
  • Suicidal ideation

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Kamali, M., Reilly-Harrington, N. A., Chang, W. C., McInnis, M., McElroy, S. L., Ketter, T. A., ... Nierenberg, A. A. (2019). Bipolar depression and suicidal ideation: Moderators and mediators of a complex relationship. Journal of Affective Disorders, 259, 164-172. https://doi.org/10.1016/j.jad.2019.08.032

Bipolar depression and suicidal ideation : Moderators and mediators of a complex relationship. / Kamali, Masoud; Reilly-Harrington, Noreen A.; Chang, Weilynn C.; McInnis, Melvin; McElroy, Susan L.; Ketter, Terence A.; Shelton, Richard C.; Deckersbach, Thilo; Tohen, Mauricio; Kocsis, James H.; Calabrese, Joseph R.; Gao, Keming; Thase, Michael E.; Bowden, Charles L.; Kinrys, Gustavo; Bobo, William V; Brody, Benjamin D.; Sylvia, Louisa G.; Rabideau, Dustin J.; Nierenberg, Andrew A.

In: Journal of Affective Disorders, Vol. 259, 01.12.2019, p. 164-172.

Research output: Contribution to journalArticle

Kamali, M, Reilly-Harrington, NA, Chang, WC, McInnis, M, McElroy, SL, Ketter, TA, Shelton, RC, Deckersbach, T, Tohen, M, Kocsis, JH, Calabrese, JR, Gao, K, Thase, ME, Bowden, CL, Kinrys, G, Bobo, WV, Brody, BD, Sylvia, LG, Rabideau, DJ & Nierenberg, AA 2019, 'Bipolar depression and suicidal ideation: Moderators and mediators of a complex relationship', Journal of Affective Disorders, vol. 259, pp. 164-172. https://doi.org/10.1016/j.jad.2019.08.032
Kamali M, Reilly-Harrington NA, Chang WC, McInnis M, McElroy SL, Ketter TA et al. Bipolar depression and suicidal ideation: Moderators and mediators of a complex relationship. Journal of Affective Disorders. 2019 Dec 1;259:164-172. https://doi.org/10.1016/j.jad.2019.08.032
Kamali, Masoud ; Reilly-Harrington, Noreen A. ; Chang, Weilynn C. ; McInnis, Melvin ; McElroy, Susan L. ; Ketter, Terence A. ; Shelton, Richard C. ; Deckersbach, Thilo ; Tohen, Mauricio ; Kocsis, James H. ; Calabrese, Joseph R. ; Gao, Keming ; Thase, Michael E. ; Bowden, Charles L. ; Kinrys, Gustavo ; Bobo, William V ; Brody, Benjamin D. ; Sylvia, Louisa G. ; Rabideau, Dustin J. ; Nierenberg, Andrew A. / Bipolar depression and suicidal ideation : Moderators and mediators of a complex relationship. In: Journal of Affective Disorders. 2019 ; Vol. 259. pp. 164-172.
@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.}",
year = "2019",
month = "12",
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",

}

TY - JOUR

T1 - Bipolar depression and suicidal ideation

T2 - Moderators and mediators of a complex relationship

AU - Kamali, Masoud

AU - Reilly-Harrington, Noreen A.

AU - Chang, Weilynn C.

AU - McInnis, Melvin

AU - McElroy, Susan L.

AU - Ketter, Terence A.

AU - Shelton, Richard C.

AU - Deckersbach, Thilo

AU - Tohen, Mauricio

AU - Kocsis, James H.

AU - Calabrese, Joseph R.

AU - Gao, Keming

AU - Thase, Michael E.

AU - Bowden, Charles L.

AU - Kinrys, Gustavo

AU - Bobo, William V

AU - Brody, Benjamin D.

AU - Sylvia, Louisa G.

AU - Rabideau, Dustin J.

AU - Nierenberg, Andrew A.

PY - 2019/12/1

Y1 - 2019/12/1

N2 - 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.

AB - 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.

KW - Bipolar disorder

KW - Depression

KW - Lithium

KW - Quetiapine

KW - Suicidal ideation

UR - http://www.scopus.com/inward/record.url?scp=85070911335&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070911335&partnerID=8YFLogxK

U2 - 10.1016/j.jad.2019.08.032

DO - 10.1016/j.jad.2019.08.032

M3 - Article

C2 - 31445343

AN - SCOPUS:85070911335

VL - 259

SP - 164

EP - 172

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

ER -