Abstract
Suicidal behavior is often conceptualized as a response to overwhelming stress. Our model posits that given a propensity for acting on suicidal urges, stressors such as life events or major depressive episodes (MDEs) determine the timing of suicidal acts. Depressed patients (n=415) were assessed prospectively for suicide attempts and suicide, life events and MDE over 2 years. Longitudinal data were divided into 1-month intervals characterized by MDE (yes/no), suicidal behavior (yes/no) and life event scores. Marginal logistic regression models were fit, with suicidal behavior as the response variable and MDE and life event score in either the same or previous month, respectively, as time-varying covariates. Among 7843 person–months, 33% had MDE and 73% had life events. MDE increased the risk for suicidal behavior (odds ratio (OR)=4.83, P⩽0.0001). Life event scores were unrelated to the timing of suicidal behavior (OR=1.06 per 100 point increase, P=0.32), even during a MDE (OR=1.12, P=0.15). However, among those without borderline personality disorder (BPD), both health- and work-related life events were key precipitants, as was recurrent MDE, with a 13-fold effect. The relationship of life events to suicidal behavior among those with BPD was more complex. Recurrent MDE was a robust precipitant for suicidal behavior, regardless of BPD comorbidity. The specific nature of life events is key to understanding the timing of suicidal behavior. Given unanticipated results regarding the role of BPD and study limitations, these findings require replication. Of note, that MDE, a treatable risk factor, strongly predicts suicidal behaviors is cause for hope.
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Acknowledgements
This work was supported by P50 MH62185, MH48514, MH59710, AA15630, Nina Rahn Fund, Medical Research Service, Veterans Affairs James J Peters VAMC, Veterans Affairs NY/NJ (VISN3), and Mental Illness Research Education and Clinical Center.
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Dr Oquendo receives royalties from the Columbia Suicide Severity Rating Scale and received educational grants from Astra Zeneca, Pfizer, Eli Lilly, Shire, Janssen. Her family owns Bristol-Myers Squibb stock. Dr Mann received grants from GlaxoSmithKline and Novartis. Dr Sullivan is on the SAB of TONIX Pharmaceuticals and consulted to Ono Pharma USA. Dr Sublette received a grant from Unicity International of nutritional supplements. The remaining authors declare no conflict of interest.
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Oquendo, M., Perez-Rodriguez, M., Poh, E. et al. Life events: a complex role in the timing of suicidal behavior among depressed patients. Mol Psychiatry 19, 902–909 (2014). https://doi.org/10.1038/mp.2013.128
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DOI: https://doi.org/10.1038/mp.2013.128
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