Predictors of suicidal ideation trajectories in the Sequenced Treatment Alternatives to Relieve Depression (STARD) study

A better understanding of suicidal ideation (SI), including patterns of SI, may help elucidate links between depression, SI, and suicidal behavior. This study sought to identify trajectories of SI in a large, community-based clinical trial of participants with major depressive disorder (MDD) and to...

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Bibliographic Details
Published in:Journal of psychiatric research 2022-04, Vol.148, p.9-13
Main Authors: Bloomfield-Clagett, Bartholt, Greenstein, Dede K., Kush, Joseph M., Musci, Rashelle, Zarate, Carlos A., Ballard, Elizabeth D.
Format: Article
Language:English
Subjects:
Anhedonia
Anxiety
Clinical trial
Depression
Depressive Disorder, Major - diagnosis
Depressive Disorder, Major - drug therapy
Humans
Suicidal Ideation
Suicide
Suicide, Attempted
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Summary:A better understanding of suicidal ideation (SI), including patterns of SI, may help elucidate links between depression, SI, and suicidal behavior. This study sought to identify trajectories of SI in a large, community-based clinical trial of participants with major depressive disorder (MDD) and to investigate the relationships between these trajectories and predictors of interest, including anxiety and anhedonia. A longitudinal latent class analysis was conducted in 3923 participants enrolled in Level 1 of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study of citalopram for the treatment of MDD. An unconditional latent class analysis was conducted using SI at study weeks 0, 2, 4, 6, and 9 as the indicators. A multinomial regression was then conducted with SI trajectory as the outcome and anhedonia, severity of depressive symptoms, atypical depression, anxiety, history of suicide attempt, history of substance abuse, history of trauma, and other covariates as the predictors. Four SI trajectories were identified: 1) variable SI; 2) little-to-no SI; 3) persistent SI; and 4) improving SI. Compared to the little-to-no SI trajectory, those with more severe anhedonia were more likely to experience persistent SI, while those with more severe anxiety were more likely to experience improving SI. Factors that distinguish SI trajectories, such as anxiety and anhedonia, may be critical targets for intervention or profiles for prognosis.
ISSN:0022-3956
1879-1379
DOI:10.1016/j.jpsychires.2022.01.027