title: Suicide attempts in major depressive episode: evidence from the BRIDGE-II-Mix study.
abstract: OBJECTIVE
  The Bipolar Disorders: Improving Diagnosis, Guidance, and Education (BRIDGE-II-Mix) study aimed to estimate the frequency of mixed states in patients with a major depressive episode (MDE) according to different definitions and to compare their clinical validity, looking into specific features such as suicidality.
  
  
  METHODS
  A total of 2,811 subjects were enrolled in this multicenter cross-sectional study. Psychiatric symptoms, and sociodemographic and clinical variables were collected. The analysis compared the characteristics of patients with MDE with (MDE-SA group) and without (MDE-NSA) a history of suicide attempts.
  
  
  RESULTS
  The history of suicide attempts was registered in 628 patients (22.34%). In the MDE-SA group, women (72.5%, p = 0.028), (hypo)mania in first-degree relatives (20.5%, p < 0.0001), psychotic features (15.1%, p < 0.0001), and atypical features (9.2%, p = 0.009) were more prevalent. MDE-SA patients' previous responses to treatment with antidepressants included more (hypo)manic switches [odds ratio (OR) = 1.97, 95% confidence interval (CI): 1.58-2.44, p < 0.0001], treatment resistance (OR = 2.07, 95% CI: 1.72-2.49, p < 0.0001), mood lability (OR = 1.98, 95% CI: 1.65-2.39, p < 0.0001), and irritability (OR = 1.80, 95% CI: 1.48-2.17, p < 0.0001). Multivariate analysis evidenced that risky behavior, psychomotor agitation and impulsivity, and borderline personality and substance use disorders were the variables most frequently associated with previous suicide attempts. In the MDE-SA group, 75 patients (11.9%) fulfilled Diagnostic and Statistical Manual (DSM)-5 criteria for MDE with mixed features, and 250 patients (39.8%) fulfilled research-based diagnostic criteria for a mixed depressive episode.
  
  
  CONCLUSIONS
  Important differences between MDE-SA and MDE-NSA patients have emerged. Early identification of symptoms such as risky behavior, psychomotor agitation, and impulsivity in patients with MDE, and treatment of mixed depressive states could represent a major step in suicide prevention.
authors.affiliation: Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: Dina
authors.initials: D
authors.lastname: Popovic
authors.affiliation: Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
authors.affiliation: Hôpital Sainte-Marguerite, Marseille, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Azorin
authors.affiliation: Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Jules
authors.initials: J
authors.lastname: Angst
authors.affiliation: University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bowden
authors.affiliation: Moscow Research Institute of Psychiatry, Moscow, Russia.
authors.forename: Sergey
authors.initials: S
authors.lastname: Mosolov
authors.affiliation: King's College, London, UK.
authors.forename: Allan H
authors.initials: AH
authors.lastname: Young
authors.affiliation: Dipartmento di Medicina Sperimentale, Clinica Psichiatrica, University of Pisa, Pisa, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Perugi
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001526:Behavioral Symptoms / Q000175:diagnosis / Q000453:epidemiology; D001883:Borderline Personality Disorder / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003710:Demography; D003865:Major Depressive Disorder / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011595:Psychomotor Agitation / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D000092864:Suicide Prevention
chemical_list: D000928:Antidepressive Agents
keywords: bipolar disorder; mixed features; suicide attempts