While extensive work has been conducted regarding risk factors for suicide attempts and deaths, clinical prediction of suicide-related behaviour at an individual level remains an unmet challenge.1 Given this reality, some have recommended a shift from risk prediction to risk management and a focus on formulation and therapeutic engagement.2 There is a paucity of prospective data directly comparing suicidal behaviour across commonly encountered psychiatric conditions and their symptom severity. Major depressive disorder (MDD), bipolar disorder (BD) and borderline personality disorder (BPD) are known to be associated with higher risk for suicidal ideation, suicide attempt and death by suicide than the general population, especially during the course of major depressive episodes (MDEs).3 Mood disorders and BPD also frequently co-occur, with about 20% of adults with BD having comorbid BPD and an even higher frequency of BPD traits.4, 5 The dynamic interplay between depressive symptom fluctuation, baseline BPD traits and emergence of suicidal behaviour is of great clinical relevance. In this edition of the journal, Isometsä et al. examine suicide attempts and suicidal ideation prospectively in a cohort of outpatients with an MDE within the context of MDD, BD or comorbid with BPD.6 Findings include higher rates of suicide attempts in those with BPD, a correlation between suicide attempts/suicidal ideation and BPD symptom severity as measured by the borderline personality disorder severity index (BPDSI) at baseline, and a correlation between severity of suicidal ideation and depressive symptom severity. Although the rates of suicidal ideation and attempts are lower over the period of follow up in the BD group than in the other two groups, the link between depression severity changes and suicidality is greater in this group. Hopelessness is found to be a transdiagnostic predictor of suicidal ideation. Interestingly, non-suicidal self-injury (NSSI) is also high in the MDD group, and not only in the BPD group. NSSI is lower in the BD group ...
Language: en
LA - en SN - 0001-690X UR - http://dx.doi.org/10.1111/acps.13600 ID - ref1 ER -