Suicide attempts in major depressive episode: evidence from the BRIDGE‐II‐Mix study

Objectives 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.