Macellaro Monica, Cafaro Rita, Kelly Carlton Max, Ostacher Michael J, Dell'Osso Bernardo, Lyu Jihun, Frye Mark A, Kupka Ralph W, McElroy Susan L, Nolen Willem A, Jr Keck Paul E, Post Robert M, Grunze Heinz, Suppes Trisha
Department of Biomedical and Clinical Sciences "Luigi Sacco", Department of Psychiatry, University of Milan, Milan, Italy.
Department of Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave. 151T, Palo Alto, CA, 94304, USA.
Int J Bipolar Disord. 2025 Jun 14;13(1):23. doi: 10.1186/s40345-025-00390-x.
While bipolar disorder is strongly linked to an increased risk of suicide, recent evidence has challenged the assumption that mixed symptoms play a distinct role in suicidal ideation beyond depressive severity. This study examines how depressive, hypo/manic, and mixed features influence suicidal ideation in individuals with bipolar disorder. Data from 903 participants in the Stanley Foundation Bipolar Network (1995-2002) were analyzed to assess associations between mood states, classified by the Inventory of Depressive Symptomatology-Clinician-Rated (IDS-C) and the Young Mania Rating Scale (YMRS), and suicidal ideation, measured using IDS-C item 18, using generalized estimating equations.
Depressive symptoms were strongly associated with suicidal ideation (OR = 21.98, 95% CI: 15.31-31.54). Moderate hypo/manic symptoms also conferred risk (OR = 3.11, 95% CI: 1.51-6.49), and milder hypo/mania showed a weaker but significant association (OR = 1.74, 95% CI: 1.05-2.89). The highest suicidal ideation was observed in individuals with hypo/mania featuring mixed symptoms (OR = 29.43), exceeding that of depression or depression with mixed features (OR = 21.98). However, findings diverged based on modeling approach: in continuous predictor models, SI was driven solely by depressive symptom severity, with no significant association observed for hypo/mania or its interaction with depression. In contrast, when mood states were categorized using clinically meaningful thresholds, hypo/mania with mixed features emerged as a distinct contributor to suicidal ideation risk.
These findings underscore the need for integrating both dimensional and categorical approaches to mood state classification in research on suicidality in bipolar disorder.
虽然双相情感障碍与自杀风险的增加密切相关，但最近的证据对混合症状在自杀观念中所起的作用提出了挑战，即认为混合症状在自杀观念中所起的作用不同于抑郁严重程度。本研究探讨了抑郁、轻躁狂和混合特征如何影响双相情感障碍患者的自杀观念。对斯坦利基金会双相情感障碍网络（1995 - 2002年）中903名参与者的数据进行了分析，以评估使用抑郁症状量表 - 临床评定版（IDS - C）和杨氏躁狂量表（YMRS）分类的情绪状态与使用IDS - C第18项测量的自杀观念之间的关联，采用广义估计方程。
抑郁症状与自杀观念密切相关（OR = 21.98，95% CI：15.31 - 31.54）。中度轻躁狂症状也会增加风险（OR = 3.11，95% CI：1.51 - 6.49），轻度轻躁狂表现出较弱但显著的关联（OR = 1.74，95% CI：1.05 - 2.89）。在具有混合症状的轻躁狂个体中观察到最高的自杀观念（OR = 29.43），超过了单纯抑郁或伴有混合特征的抑郁（OR = 21.98）。然而，根据建模方法的不同，结果有所差异：在连续预测模型中，自杀观念仅由抑郁症状严重程度驱动，未观察到轻躁狂及其与抑郁的相互作用有显著关联。相比之下，当使用具有临床意义的阈值对情绪状态进行分类时，具有混合特征的轻躁狂成为自杀观念风险的一个独特因素。
这些发现强调了在双相情感障碍自杀研究中，需要将维度和分类方法相结合来进行情绪状态分类。
