Does Response on the PHQ-9 Depression Questionnaire Predict Subsequent Suicide Attempt or Suicide Death?

Abstract Background Suicide risk prediction models have been developed by using information from patients' electronic health records (EHR), but the time elapsed between model development and health system implementation is often substantial. Temporal changes in health systems and EHR coding practices necessitate the evaluation of such models in more contemporary data. Objectives A set of published suicide risk prediction models developed by using EHR data from 2009 to 2015 across seven health systems reported c-statistics of 0.85 for suicide attempt and 0.83 to 0.86 for suicide death. Our objective was to evaluate these models' performance with contemporary data (2014–2017) from these systems. Methods We evaluated performance using mental health visits (6,832,439 to mental health specialty providers and 3,987,078 to general medical providers) from 2014 to 2017 made by 1,799,765 patients aged 13+ across the health systems. No visits in our evaluation were used in the previous model development. Outcomes were suicide attempt (health system records) and suicide death (state death certificates) within 90 days following a visit. We assessed calibration and computed c-statistics with 95% confidence intervals (CI) and cut-point specific estimates of sensitivity, specificity, and positive/negative predictive value. Results Models were well calibrated; 46% of suicide attempts and 35% of suicide deaths in the mental health specialty sample were preceded by a visit (within 90 days) with a risk score in the top 5%. In the general medical sample, 53% of attempts and 35% of deaths were preceded by such a visit. Among these two samples, respectively, c-statistics were 0.862 (95% CI: 0.860–0.864) and 0.864 (95% CI: 0.860–0.869) for suicide attempt, and 0.806 (95% CI: 0.790–0.822) and 0.804 (95% CI: 0.782–0.829) for suicide death. Conclusion Performance of the risk prediction models in this contemporary sample was similar to historical estimates for suicide attempt but modestly lower for suicide death. These published models can inform clinical practice and patient care today.

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Mapping the genetic architecture of suicide attempt and suicide death using polygenic risk scores for clinically-related psychiatric disorders and traits

Psychological Medicine ◽

10.1017/s0033291721004700 ◽

2021 ◽

pp. 1-9

Author(s):

Ikuo Otsuka ◽

Hanga Galfalvy ◽

Jia Guo ◽

Masato Akiyama ◽

Dan Rujescu ◽

...

Keyword(s):

Suicide Attempt ◽

Psychiatric Disorders ◽

Suicidal Behavior ◽

Statistical Power ◽

Small Sample ◽

European Ancestry ◽

Risk Scores ◽

Suicide Attempters ◽

Polygenic Risk ◽

Suicide Death

Abstract Background Suicidal behavior is moderately heritable and a consequence of a combination of the diathesis traits for suicidal behavior and suicide-related major psychiatric disorders. Here, we sought to examine shared polygenic effects between various psychiatric disorders/traits and suicidal behavior and to compare the shared polygenic effects of various psychiatric disorders/traits on non-fatal suicide attempt and suicide death. Methods We used our genotyped European ancestry sample of 260 non-fatal suicide attempters, 317 suicide decedents and 874 non-psychiatric controls to test whether polygenic risk scores (PRSs) obtained from large GWASs for 22 suicide-related psychiatric disorders/traits were associated with suicidal behavior. Results were compared between non-fatal suicide attempt and suicide death in a sensitivity analysis. Results PRSs for major depressive disorder, bipolar disorder, schizophrenia, ADHD, alcohol dependence, sensitivity to environmental stress and adversity, educational attainment, cognitive performance, and IQ were associated with suicidal behavior (Bonferroni-corrected p < 2.5 × 10−4). The polygenic effects of all 22 psychiatric disorders/traits had the same direction (p for binomial tests = 4.8 × 10−7) and were correlated (Spearman's ρ = 0.85) between non-fatal suicide attempters and suicide decedents. Conclusions We found that polygenic effects for major psychiatric disorders and diathesis-related traits including stress responsiveness and intellect/cognitive function contributed to suicidal behavior. While we found comparable polygenic architecture between non-fatal suicide attempters and suicide decedents based on correlations with PRSs of suicide-related psychiatric disorders/traits, our analyses are limited by small sample size resulting in low statistical power to detect difference between non-fatal suicide attempt and suicide death.

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Genetic liability to suicide attempt, suicide death, and psychiatric and substance use disorders on the risk for suicide attempt and suicide death: a Swedish national study

Psychological Medicine ◽

10.1017/s0033291721003354 ◽

2021 ◽

pp. 1-10

Author(s):

Kenneth S. Kendler ◽

Henrik Ohlsson ◽

Eve K. Mościcki ◽

Jan Sundquist ◽

Alexis C. Edwards ◽

...

Keyword(s):

Suicide Attempt ◽

Psychiatric Disorders ◽

Genetic Risk ◽

Risk Scores ◽

National Study ◽

Multivariate Models ◽

Genetic Liability ◽

Suicide Death ◽

Younger Age ◽

The Impact

Abstract Background How does genetic liability to suicide attempt (SA), suicide death (SD), major depression (MD), bipolar disorder (BD), schizophrenia (SZ), alcohol use disorder (AUD), and drug use disorder (DUD) impact on risk for SA and SD? Methods In the Swedish general population born 1932–1995 and followed through 2017 (n = 7 661 519), we calculate family genetic risk scores (FGRS) for SA, SD, MD, BD, SZ, AUD, and DUD. Registration for SA and SD was assessed from Swedish national registers. Results In univariate and multivariate models predicting SA, FGRS were highest for SA, AUD, DUD, and MD. In univariate models predicting SD, the strongest FGRS were AUD, DUD, SA, and SD. In multivariate models, the FGRS for SA and AUD were higher in predicting SA while the FGRS for SD, BD, and SZ were higher in predicting SD. Higher FGRS for all disorders significantly predicted both younger age at first SA and frequency of attempts. For SD, higher FGRS for MD, AUD, and SD predicted later age at SD. Mediation of FGRS effects on SA and SD was more pronounced for SD than SA, strongest for AUD, DUD, and SZ FGRS and weakest for MD. Conclusions FGRS for both SA and SD and for our five psychiatric disorders impact on risk for SA and SD in a complex manner. While some of the impact of genetic risk factors for psychiatric disorders on risk for SA and SD is mediated through developing the disorders, these risks also predispose directly to suicidal behaviors.

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Questions Regarding Study Design and Analysis in “Previous Suicide Attempt and its Association With Method Used in a Suicide Death”

American Journal of Preventive Medicine ◽

10.1016/j.amepre.2017.05.012 ◽

2017 ◽

Vol 53 (5) ◽

pp. e191

Author(s):

Claire Lefebvre ◽

Isabelle Malhamé ◽

Maida J. Sewitch

Keyword(s):

Suicide Attempt ◽

Study Design ◽

Suicide Death ◽

Previous Suicide Attempt

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Response to Letter to the Editor: “Questions Regarding Study Design and Analysis in ‘Previous Suicide Attempt and its Association With Method Used in a Suicide Death’”

American Journal of Preventive Medicine ◽

10.1016/j.amepre.2017.05.009 ◽

2017 ◽

Vol 53 (5) ◽

pp. e193

Author(s):

Ethan C. Jamison ◽

Kirk A. Bol

Keyword(s):

Suicide Attempt ◽

Study Design ◽

Suicide Death ◽

Letter To The Editor ◽

Previous Suicide Attempt

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Previous Suicide Attempt and Its Association With Method Used in a Suicide Death

American Journal of Preventive Medicine ◽

10.1016/j.amepre.2016.07.023 ◽

2016 ◽

Vol 51 (5) ◽

pp. S226-S233 ◽

Cited By ~ 12

Author(s):

Ethan C. Jamison ◽

Kirk A. Bol

Keyword(s):

Suicide Attempt ◽

Suicide Death ◽

Previous Suicide Attempt

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Risk of re-attempts and suicide death after a suicide attempt: A survival analysis

BMC Psychiatry ◽

10.1186/s12888-017-1317-z ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 35

Author(s):

Isabel Parra-Uribe ◽

Hilario Blasco-Fontecilla ◽

Gemma Garcia-Parés ◽

Luis Martínez-Naval ◽

Oliver Valero-Coppin ◽

...

Keyword(s):

Survival Analysis ◽

Suicide Attempt ◽

Suicide Death

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Assessment of suicide attempt and death in bipolar affective disorder: a combined clinical and genetic approach

Translational Psychiatry ◽

10.1038/s41398-021-01500-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Eric T. Monson ◽

Andrey A. Shabalin ◽

Anna R. Docherty ◽

Emily DiBlasi ◽

Amanda V. Bakian ◽

...

Keyword(s):

Risk Factors ◽

Suicide Attempt ◽

Multiple Testing ◽

Bipolar Affective Disorder ◽

Logistic Models ◽

Self Report ◽

European Ancestry ◽

Suicide Death ◽

Treatment And Prevention ◽

History Of

AbstractBipolar disorder (BP) suicide death rates are 10–30 times greater than the general population, likely arising from environmental and genetic risk factors. Though suicidal behavior in BP has been investigated, studies have not addressed combined clinical and genetic factors specific to suicide death. To address this gap, a large, harmonized BP cohort was assessed to identify clinical risk factors for suicide death and attempt which then directed testing of underlying polygenic risks. 5901 individuals of European ancestry were assessed: 353 individuals with BP and 2498 without BP who died from suicide (BPS and NBPS, respectively) from a population-derived sample along with a volunteer-derived sample of 799 individuals with BP and a history of suicide attempt (BPSA), 824 individuals with BP and no prior attempts (BPNSA), and 1427 individuals without several common psychiatric illnesses per self-report (C). Clinical and subsequent directed genetic analyses utilized multivariable logistic models accounting for critical covariates and multiple testing. There was overrepresentation of diagnosis of PTSD (OR = 4.9, 95%CI: 3.1–7.6) in BPS versus BPSA, driven by female subjects. PRS assessments showed elevations in BPS including PTSD (OR = 1.3, 95%CI:1.1–1.5, versus C), female-derived ADHD (OR = 1.2, 95%CI:1.1–1.4, versus C), and male insomnia (OR = 1.4, 95%CI: 1.1–1.7, versus BPSA). The results provide support from genetic and clinical standpoints for dysregulated traumatic response particularly increasing risk of suicide death among individuals with BP of Northern European ancestry. Such findings may direct more aggressive treatment and prevention of trauma sequelae within at-risk bipolar individuals.

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