The results of a recent study from the European College of Neuropsychopharmacology (ECNP) point to risky, impulsive behaviors and agitated nervousness as warning signs of a high suicide risk in people suffering from depression.
In the study, led by Dr. Dina Popovic of the Hospital Clinic de Barcelona, researchers worked with over 2,800 people with depression, almost 630 of which had attempted suicide. Popovic’s team conducted in-depth interviews with each patient, looking especially to identify differences between those who had attempted suicide and those who had not.
The in-depth interviews are important because, according to Popovic, most of the key symptoms that indicate high suicide risk “will not be spontaneously referred [to] by the patient.” So, “the clinician needs to inquire directly” in order to establish the presence of these behaviors.
What Suicide Risks Look Like
The risky behaviors might include reckless driving or sexual behavior, maybe spontaneous drug use or dangerous drinking. The study defines impulsivity as acting “with little or no forethought, reflection, or consideration of the consequences.” The nervousness might look like what the study calls “psychomotor agitation”: wringing one’s hands, pacing around the room, pulling clothing off and then putting it back on, etc.
Popovic’s team also identified “depressive mixed states” as signs that might precede suicide attempts. “A depressive mixed state,” she explained, “is where a patient is depressed, but also has symptoms of ‘excitation,’ or mania.” In general, patients who suffer from mixed depression are at a much higher risk of suicide than those without any manic tendencies.
Improving Diagnostic Standards
Dr. Donald Malone, chair of psychiatry and psychology at the Cleveland Clinic in the U.S., concurred with the study’s findings. “It has long been known that those patients with depression who also experience anxiety and/or agitation are more likely to attempt or complete suicide,” he said. He also said that these symptoms can be a clue “that the underlying diagnosis is bipolar depression,” or manic depressive disorder.
So, Popovic’s team also worked to evaluate the current standard criteria for diagnosing depression, which tend to catch only 12 percent of patients with mixed symptoms. They tested criteria that brought that number up to 40 percent, indicating that current diagnostic methods could be doing a much better job of identifying and subsequently treating patients at higher risk of suicide.
