Department of Pathology, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, IA, USA.
Department of Methodology and Statistics, School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherland.
Psychiatry Res. 2022 Jan;307:114296. doi: 10.1016/j.psychres.2021.114296. Epub 2021 Nov 21.
Bipolar disorder is typified by episodes of manic/hypomanic and depressive symptoms, either distinctly or concurrently as mixed symptoms. While depressive symptoms are the major driver of risk, it is unclear whether specific combinations of manic and anxiety symptoms contribute differentially to suicidal ideation and behavior in individuals with bipolar disorder during a depressive state. This study uses a quantitative application of Rothman's theoretical framework of causation, or 'causal pies' model. Data were obtained from the National Network of Depression Centers Mood Outcomes Program for 1028 visits from 626 individuals with bipolar disorder with current moderate-to-severe depressive symptoms, operationalized as a Patient Health Questionnaire-8 (PHQ-8) score ≥10. Mania symptoms were captured using the Altman Self-Rating Mania scale (ASRM) and anxiety symptoms were captured using the Generalized Anxiety Disorder-7 scale (GAD-7). The outcome of suicidal ideation or behavior was captured using the Columbia Suicide Severity Rating Scale (C-SSRS). In this cohort of individuals with bipolar disorder and at least moderate depressive symptoms, we found no increased risk of suicidal ideation or behavior attributable to manic and anxiety symptom clusters in individuals with bipolar disorder during depressive state. A small amount (4%) of risk was attributable to having severe depressive symptoms. These findings, however, may be influenced by limitations in sample size and measurement instruments. Future studies would benefit from larger samples and more rigorous assessments, including clinician-rated measures.
双相情感障碍的特点是躁狂/轻躁狂和抑郁症状发作,无论是明显的还是同时出现的混合症状。虽然抑郁症状是风险的主要驱动因素,但尚不清楚在抑郁状态下,双相情感障碍个体的躁狂和焦虑症状的特定组合是否会对自杀意念和行为产生不同的影响。本研究使用了 Rothman 因果理论框架的定量应用,或“因果饼图”模型。数据来自国家抑郁中心网络的情绪结果计划,该计划从 626 名目前有中度至重度抑郁症状的双相情感障碍患者的 1028 次就诊中获得,这些症状通过患者健康问卷-8(PHQ-8)评分≥10 来确定。躁狂症状使用 Altman 自我评定躁狂量表(ASRM)来捕捉,焦虑症状使用广泛性焦虑障碍-7 量表(GAD-7)来捕捉。自杀意念或行为的结果使用哥伦比亚自杀严重程度评定量表(C-SSRS)来捕捉。在这个有双相情感障碍且至少有中度抑郁症状的个体队列中,我们没有发现躁狂和焦虑症状群在双相情感障碍个体抑郁状态下导致自杀意念或行为的风险增加。只有 4%的风险归因于严重的抑郁症状。然而,这些发现可能受到样本量和测量工具的限制的影响。未来的研究将受益于更大的样本量和更严格的评估,包括临床医生评定的测量。