Suicide is a major plight afflicting individuals of all-age groups world-wide. While suicide is more frequent in older individuals, it remains the second leading cause of death of 15-29 year olds across the globe (Bilsen, 2018).
Youth suicidality leaves a lasting mark both on surviving loved ones, as well as on society as a whole, through losing potentially vital contributors to all societal domains, such as the economy, infrastructure, and health care. The issue is that, while monitoring individuals with depression can help to spot potential suicides, being able to predict suicidal behavior, either attempts or ideation, is still a very difficult task.
A recent study by Melhem et al. (2019) suggests that severity and variability in depressive symptoms in young adults are significant predictors of suicide, even more so than psychiatric diagnoses for clinical depression.
In this multicenter, longitudinal study, young adults whose parents had a history of mood disorders (making them a high-risk population) were interviewed and assessed using the Columbia Suicide History Form and the Medical Lethality Ratings Scale, with depression screened for using the Children’s Depression Inventory for those under 18 years old, and the Beck Depression Inventory for individuals at or over age 18.
Doing so, the authors were able to screen for depressive symptoms, irritability, impulsivity, aggression, and hopelessness. The authors assessed, over time, whether changes in any of these measures were predictive of frequency in suicidal attempts, as well as when suicidal attempts occurred.
What they found was that the severity of depressive symptoms, and fluctuations in measures of depression, were the two strongest predictive factors of suicidal attempts. This was a statistically-significant trend not seen in the other measures.
The authors also took note of all the various demographic characteristics of the study participants, and determined other significant prognostic factors (albeit not as significant as severity and variability in depression). The demographic predictors for future suicidal attempts that they found were as follows: being under the age of 30, the presence of an underlying mood disorder, a history of childhood abuse, a prior history of suicide attempt, and having biological parents who attempted suicide themselves.
Using severity and variability in depressive symptoms, and the demographic predictors above, the authors also created a novel predictive risk score (PRS) for suicidal attempts, and looked to see if this risk score could also help predict suicide risk in young, high-risk individuals. What they concluded was that a score of three or more of these risk factors were indicative of a higher risk for suicidal behavior.
However, the biggest takeaway of the study is that depression must be monitored in such high-risk individuals, particularly for escalating severity and significant fluctuations over a prolonged period of time.
How Can We Apply This Information to a Clinical Setting?
What can be done to effectively screen for severe and fluctuating depression, as well as to apply this study’s risk score, is to ensure that screening for these suicide measures is done in the primary care setting. For instance, many developed countries such as Canada, the U.K, and many European nations, recommend screening for depression in the context of primary care. If this method is implemented, what needs to taken into account is the fact that many patients tend not to complete depression screens, or refuse to take them altogether.
Primary care providers need to be persistent and ensure that the patients actually complete these screening procedures.
After screening, it is essential to ensure that there is effective and immediate treatment. The moment suicide risk is spotted, a team of mental health professionals must respond in a timely manner with psychotherapeutic approaches such as cognitive behavioral therapy (CBT) and, if needed, supplemented with pharmacotherapy such as selective serotonin reuptake inhibitors (SSRIs).
Just as vital as treatment is follow-up and repeated screening. A permanent cure for depression eludes us even today, and relapse to depression is all too common. Following up with patients and repeating the screening process is essential to preventing relapse to suicidal ideation and attempts (Bowers et al., 2018).
The results of this study still need to be substantiated through future investigations and supplemented with the discovery of potential biomarkers for suicide.
The results are certainly indicative of potential means by which individuals at a high-risk for suicide can be detected before the tragic events even manifest themselves. Effective screening for severe and fluctuating depression, taking the aforementioned demographic risk factors into account, can allow for earlier intervention and treatment. This approach may allow these young adults to go on and enjoy fulfilling, successful lives.
Furthermore, they, their loved ones, and society as a whole will no longer have to bear the traumatic yoke of suicidal ideation, suicidal attempts, or worse, the actual tragedy of a suicide itself.
Bilsen J. (2018). Suicide and Youth: Risk Factors. Frontiers in psychiatry, 9, 540. doi:10.3389/fpsyt.2018.00540
Bowers, A., Meyer, C., Hillier, S., Blubaugh, M., Roepke, B., Farabough, M., . . . Vassar, M. (2018). Suicide risk assessment in the emergency department: Are there any tools in the pipeline? The American Journal of Emergency Medicine, 36(4), 630-636. doi:10.1016/j.ajem.2017.09.044
Melhem, N. M., Porta, G., Oquendo, M. A., Zelazny, J., Keilp, J. G., Iyengar, S., . . . Brent, D. A. (2019). Severity and Variability of Depression Symptoms Predicting Suicide Attempt in High-Risk Individuals. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2018.4513