Moderators of the association between depressive, manic, and mixed mood symptoms and suicidal ideation and behavior: An analysis of the National Network of Depression Centers Mood Outcomes Program

Jess G. Fiedorowicz, Jane E. Persons, Shervin Assari, Michael J. Ostacher, Fernando S. Goes, John I. Nurnberger, and William H. Coryell

There is a lack of research exploring the relationship between different symptom profiles in people with bipolar disorder and suicide risk. To address this, using data from the National Network of Depression Centers Mood Outcomes Program, we explored the various factors that can either strengthen or weaken the association between symptoms of depression, mania, mixed mood, and suicidal thoughts or behaviors in 6,105 patients (998 with bipolar disorder and 5,117 with major depression).

We measured symptoms of depression, mania/hypomania, and their interaction and explored their impact on suicidal ideation and behaviours. We found that depressive symptoms had the strongest association with suicide risk across diagnoses (bipolar disorder and major depressive disorder). There was no relationship between suicide risk and mania/hypomania or mixed symptoms and suicide risk. We did not find any differences based on sex, race, or mood disorder polarity.

Consistent with other research, we found a strong relationship between depressive symptoms alone and suicidal ideations and behaviours which can be a potentially modifiable risk factor for dying by suicide.