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The latest medical research on Depression

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Torn between living or dying-analyses of influencing factors on suicide ambivalence and its longitudinally impact on suicidal ideation and behavior in a high-risk sample.

Suicide Life Threat

Findings on the role of suicide ambivalence, an individual's wish to live (WL), and wish to die (WD) in the development of suicidality have been heterogenous. The main goal of this study was to examine associations of these constructs within the past week with sociodemographic factors and to longitudinally investigate their predictive power for suicidal ideation (SI) and suicide attempts (SA).

N = 308 patients (54% female; M = 36.92 years, SD = 14.30), admitted to a psychiatric ward due to suicidality, were assessed for all constructs after admission, after six, nine, and 12 months. Data were analyzed with univariate fixed-effect models and lagged mixed-effect regression models.

Decreased, WL increased post-baseline. Gender showed no significant link to ambivalence, WD, and WL. Ambivalence and WD correlated negatively with age and positively with depressiveness. More participants in a relationship showed a WL compared with single/divorced/widowed participants. More single participants or those in a relationship showed ambivalence than divorced/widowed participants. More single participants showed a WD than participants in a relationship/divorced/widowed. Longitudinally, ambivalence and WD predicted SI and SA.

The findings underscore the importance of taking suicide ambivalence and WD into account in risk assessment and treatment.

Retraction: Suicidal thoughts and behaviors among gender and sexual minorities: Adults ages 25-44 show highest rates of past month suicidal thoughts. Suicide and Life-Threatening Behavior.

Suicide Life Threat

Manges, M. E., Bryan, C. J., Bryan, AB. O., Bauder, C. R., Wastler, H. M. (2023). Suicidal thoughts and behaviors among gender and sexual minoritie...

The efficacy of lamotrigine in bipolar disorder: A systematic review and meta-analysis.

Bipolar Disorders

To provide up-to-date clinical guidance on the efficacy of lamotrigine in bipolar disorder (BD).

Eligible studies were identified during a systematic literature search according to PRISMA-guidelines. We included randomized controlled trials (RCTs) and cohort studies that quantitatively assessed lamotrigine's efficacy in BD. We divided the included studies into three groups: 1. acute treatment of depression, 2. acute treatment of mania and hypomania, and 3. maintenance treatment. Analyses were stratified by control group (placebo vs active comparator) and treatment strategy (monotherapy vs add-on treatment).

We included 20 RCTs (n = 1166 lamotrigine users) and 20 cohort studies (n = 11,141 lamotrigine users). Twenty-four of these studies were included in meta-analyses. During depressive episodes, greater decreases in depressive symptomatology were associated with initiation of lamotrigine as add-on treatment than with placebo (SMD -0.30 [95% CI = -0.51, -0.10], df = 3, p = 0.004). Decreases in depressive symptomatology did not differ significantly between lamotrigine and the active comparator (SMD -0.28 [95% CI = -1.06, 0.50], df = 3, p = 0.488). As a maintenance treatment, lamotrigine was associated with a significantly lower relapse/recurrence rate than placebo (risk ratio (RR) 0.84 [95% CI = 0.71, 0.99], df = 2, p = 0.037). Relapse/recurrence rates did not differ significantly between lamotrigine and lithium (RR 1.06 [95% CI = 0.89, 1.25], df = 2, p = 0.513). A qualitative assessment of high-quality register-based studies found that lamotrigine was associated with lower hospital admission rates than other commonly used treatment regimes.

There is substantial evidence for the efficacy of lamotrigine in BD, specifically as add-on treatment during acute depressive episodes and as maintenance treatment for preventing relapse and recurrence.

Intentions to use mental health and suicide prevention resources among individuals with symptoms of the suicide crisis syndrome and/or suicidal ideation.

Suicide Life Threat

The suicide crisis syndrome (SCS) has demonstrated efficacy in predicting suicide attempts, showing potential utility in detecting at-risk individuals who may not be willing to disclose suicidal ideation (SI). The present international study examined differences in intentions to utilize mental health and suicide prevention resources among community-based adults with varying suicide risk (i.e., presence/absence of SCS and/or SI).

A sample of 16,934 community-based adults from 13 countries completed measures about the SCS and SI. Mental health and suicide prevention resources were provided to all participants, who indicated their intentions to use these resources.

Individuals with SCS (55.7%) were just as likely as those with SI alone (54.0%), and more likely than those with no suicide-related symptoms (45.7%), to report willingness to utilize mental health resources. Those with SI (both with and without SCS) were more likely to seek suicide prevention resources (52.6% and 50.5%, respectively) than those without SI (41.7% and 41.8%); however, when examining endorsements for personal use, those with SCS (21.6%) were more likely to use resources than individuals not at risk (15.1%).

These findings provide insight into individuals' willingness to use resources across configurations of explicitly disclosed (SI) and indirect (SCS) suicide risk.

Eco-anxiety: Towards a medical model and the new framework of ecolalgia.

Bipolar Disorders

In the context of global warming, new terms emerged in the global media and in the psychology field to embody the negative feelings which come along with climate change such as 'eco-anxiety' or 'solastalgia'. The pathological character of these emotions is denied although medical opinion is often required for helping people to handle them. Also, no proper medical framework in the field exists to study and care for these patients.

In this narrative review, we aim to (1) analyse the concept of eco-anxiety by focusing on its history and developed concepts, (2) summarize the different scales built to assess eco-anxiety and (3) propose a new medical framework.

We came out with a framework based on the transformation of a physiological adaptative behaviour the 'eco-distress'. It is composed of three dimensions: eco-anger, eco-grief and eco-worry, it is not debilitating in daily life and promotes coping strategies such as management of negative emotions and pro-environmental behaviours (PEB). It can transform itself into a pathological state, the 'ecolalgia', composed of two core dimensions: eco-anxiety and eco-depression, leading to functional impairment and decrease in PEB. If ecolalgia maintains over 15 days, we propose to consider it as a full psychiatric disorder needing medical advice.

This new framework enables a novel approach that is necessary for the improved management of mental health issues related to climate change.

A comparison of the social cognition and neurocognitive characteristics of adolescents with suicide behavior, adolescent with depression and healthy controls.

Suicide Life Threat

Deficits in neurocognition and social-cognition have been suggested to be an endophenotype for suicidal behavior. We aimed to compare the social-cognition and neurocognitive characteristics of adolescents diagnosed with depression with and without suicidal behavior and to investigate whether these functions predict suicide.

Adolescents diagnosed with Major Depressive Disorder (MDD) with suicidal behavior (n = 42); MDD without suicidal behavior (n = 44) and age- and sex-matched controls (n = 43) were included. The University of Pennsylvania Computerized Neurobehavioral Test Battery and Autism Spectrum Screening Questionnaire (ASSQ) were used to evaluate social-cognition and neurocognitive characteristics.

Several neurocognitive domain values of MDD groups, were significantly different from the control group. Neutral emotion recognition task (p = 0.025) and ASSQ scores were found to be significantly impaired in the patient groups (p < 0.001). Logistic regression analysis showed that, only the increase in the Suicide Probability Scale score was found to be significant as a risk factor predicting suicide (p = 0.007, OR: 1.246).

While the neurocognitive and social-cognitive performances of adolescents with MDD were significantly lower than the control group, these performances in the two depression groups were similar. When the predictors of suicidal behavior were examined, it was found that only the increase in suicidal ideation scores predicted suicide.

Suicidal ambivalence: A scoping review.

Suicide Life Threat

Suicidal ambivalence is considered a characteristic condition of suicidal individuals. At the same time, there is a lack of a uniform definition, conception and assessment of suicidal ambivalence. On this background, the current scoping review aims to explore the extent, range, and nature of research activity on suicidal ambivalence and to summarize research findings.

A systematic literature search was conducted in four different databases (PubMed, Psychinfo, Web of Science, and Google Scholar) using an array of search terms (e.g., ambivalence, internal suicide debate, reasons for living and reasons for dying, wish to live and wish to die).

In total, 28 articles published between 1977 and 2023 were included in the scoping review. The study situation lacks a clear definition, conceptualization and operationalization of suicidal ambivalence. Nonetheless, suicidal ambivalence is a common experience in persons contemplating suicide and suicidal ambivalence seems to be present before, during and after a suicide attempt. Suicidal ambivalence is associated with diverse markers of negative/positive mental health as well as suicidal ideation and behavior.

Results point to the relevance of suicidal ambivalence. At the same time, there are large gaps in knowledge about the development, impact and therapeutic responsiveness of suicidal ambivalence.

Do people know how suicidal they will be? Understanding suicidal prospection.

Suicide Life Threat

Little research has been done on how people mentally simulate future suicidal thoughts and urges, a process we term suicidal prospection.

Participants were 94 adults with recent suicidal thoughts. Participants completed a 42-day real-time monitoring study and then a follow-up survey 28 days later. Each night, participants provided predictions for the severity of their suicidal thoughts the next day and ratings of the severity of suicidal thoughts over the past day. We measured three aspects of suicidal prospection: predicted levels of desire to kill self, urge to kill self, and intent to kill self. We generated prediction errors by subtracting participants' predictions of the severity of their suicidal thoughts from their experienced severity.

Participants tended to overestimate (although the average magnitude was small and the modal error was zero) the severity of their future suicidal thoughts. The best fitting models suggested that participants used both their current suicidal thinking and previous predictions of their suicidal thinking to generate predictions of their future suicidal thinking. Finally, the average severity of predicted future suicidal thoughts predicted the number of days participants thought about suicide during the follow-up period.

This study highlights prospection as a psychological process to better understand suicidal thoughts and behaviors.

Implementation of a countywide adult suicide review commission: Development, lessons learned, and recommendations.

Suicide Life Threat

Fatality review is a public health approach designed to inform efforts to prevent fatalities of a certain kind (e.g., suicide, homicide) or in a specific setting or population (e.g., hospitals, youth). Despite extensive literature on fatality review generally, the literature on suicide review teams specifically is scant. The aim of this paper is to: describe the implementation of a local adult suicide review commission, detail examples of initial outcomes and recommendations developed by the commission, and provide recommendations and/or best practices for how to develop and implement an adult suicide review team.

We utilize framing questions from the American Association of Suicidology's psychological autopsy framework. By using these guiding questions in the discussion, members are invited to explore not only the stressors that may have more immediately preceded the suicide event itself, but to situate those stressors in the context of the individual's life course.

Several recommendations proposed by our commission have resulted in tangible outcomes and are detailed using Haddon's Matrix as a guiding prevention planning tool.

We have highlighted the need to move beyond looking at individual-level help-seeking to focus on structural/systemic issues that result in stress or create unsafe environments for at-risk individuals.

Stable neural underpinnings of emotional cognition subgroups in patients newly diagnosed with bipolar disorder: A prospective fMRI study.

Bipolar Disorders

This study aimed to investigate the neural underpinnings of emotional cognition subgroups in recently diagnosed patients with bipolar disorder (BD) and change over time over a 15-month follow-up period.

Patients and healthy controls (HC) underwent emotional and nonemotional cognitive assessments and functional magnetic resonance imaging (fMRI) at the baseline (BD n = 87; HC n = 65) and at 15-month follow-up (BD n = 44; HC n = 38). Neural activity during emotion reactivity and regulation in response to aversive pictures was assessed during fMRI. Patients were clustered into subgroups based on their emotional cognition and, with HC, were compared longitudinally on cognition and neural activity during emotion reactivity and regulation.

Patients were optimally clustered into two subgroups: Subgroup 1 (n = 40, 46%) was characterized by heightened emotional reactivity in negative social scenarios, which persisted over time, but were otherwise cognitively intact. This subgroup exhibited stable left amygdala hyper-activity over time during emotion reactivity compared to subgroup 2. Subgroup 2 (n = 47, 54%) was characterized by global emotional cognitive impairments, including stable difficulties with emotion regulation over time. During emotion regulation across both time points, this group exhibited hypo-activity in the left dorsolateral prefrontal cortex. Additionally, patients in subgroup 2 had poorer nonemotional cognition, had more psychiatric hospital admissions and history of psychotic episodes than those in subgroup 1.

Broad impairments in emotional cognition in approximately half of BD patients and associated nonemotional cognitive deficits may originate from insufficient recruitment of prefrontal resources, contributing to poorer clinical outcomes.

The Veterans Crisis Line: Relations among immediate call outcomes and treatment contact and utilization following the call.

Suicide Life Threat

Crisis line callers experience reductions in distress and suicidal ideation and utilize more health care following calls. The purpose of this study was to determine whether changes in distress and suicidal ideation during a call are associated with later healthcare contact and utilization.

Veterans Crisis Line calls from 599 veterans were extracted with call dates between 12/1/2018 and 11/30/2019. Calls were coded for changes in distress and suicidal ideation and linked with VA medical records to obtain healthcare data. Generalized Linear Mixed Modeling was used to examine the associations of changes in distress and suicidal ideation with healthcare contact (yes/no) and utilization (days of treatment) in the month (30 days) following the call.

Reductions in distress were associated with behavioral (i.e., mental and substance use) healthcare utilization, F(1, 596) = 4.52, p = 0.03, and reductions in suicidal ideation were associated with any healthcare utilization, F(1, 596) = 6.45, p = 0.01. Changes in distress and suicidal ideation were not associated with healthcare contact.

Responders need to help resolve distress and suicidal ideation and link callers with treatment. Unresolved distress and suicidal thoughts may signify later problems with treatment utilization. Research is needed to determine causality.

Validity of the DSM-5 Mixed Features Specifier Interview.

Bipolar Disorders

To examine the reliability and validity of a semi-structured interview assessing the features of the DSM-5 mixed features specifier. Our goal was to develop an instrument that could be used for both diagnostic and severity measurement purposes.

Four hundred fifty-nine psychiatric patients in a depressive episode were interviewed by a trained diagnostic rater who administered semi-structured interviews including the DSM-5 Mixed Features Specifier Interview (DMSI). We examined the inter-rater reliability and psychometric properties of the DMSI. The patients were rated on clinician rating scales of depression, anxiety, and irritability, and measures of psychosocial functioning, suicidality, and family history of bipolar disorder.

The DMSI had excellent joint-interview interrater reliability. More than twice as many patients met the DSM-5 mixed features specifier criteria during the week before the assessment than for the majority of the episode (9.4% vs. 3.9%). DMSI total scores were more highly correlated with a clinician-rated measure of manic symptoms than with measures of depression and anxiety. More patients with bipolar depression met the mixed features specifier than patients with MDD. Amongst patients with MDD, those with mixed features more frequently had a family history of bipolar disorder, were more frequently diagnosed with anxiety disorders, attention deficit disorder, and borderline personality disorder, more frequently had attempted suicide, and were more severely depressed, anxious, and irritable.

The DMSI is a reliable and valid measure of the presence of the DSM-5 mixed features specifier in depressed patients as well as the severity of the features of the specifier.