Psychotic depression and suicide risk: a mixed methods study
Keywords:
suicide, selvmord, suicide risk, psychotic depressionSynopsis
Background
The reasons behind suicide are multifactorial, complex, and poorly understood. Despite decades of research, suicide rates remain elevated both during hospitalization as well as shortly after discharge. Clinically relevant knowledge and tools for suicide risk assessments to guide decision-making processes in acute settings are needed.
Objectives
The thesis objective was to examine and improve understanding of the complex relationship between psychotic depression and suicide behaviour. We also examined risk factors of clinical relevance in hospital settings, both during treatment, and after discharge.
Methods
This research project used a sequential exploratory strategy, commencing with a qualitative part (paper 1-2), followed by a quantitative part (paper 3-4).
In paper 1 and 2, we conducted qualitative interviews with nine patients diagnosed with psychotic depression as part of uni- or bipolar disorder. Papers 3 and 4 used data from the naturalistic prospective cohort study Suicidality in Psychiatric Emergency Admissions. In paper 3, we included all patients with depression (N= 1846) in a representative sample to identify risk factors for suicide using a cox regression analysis. Paper 4 investigated a mixed diagnostic sample of 7000 acutely admitted inpatients to identify imminent- and short-term risk factors for suicide.
The findings from all four papers were combined into a secondary analysis, where we thematically synthesized the perspectives of patients’ experiences with the main findings from the prospective cohort study based on clinical assessment.
Results thematic summarized
Our main finding was that psychotic symptoms in depression are associated with increased suicide risk, both short- and long-term (Paper 3). A possible mechanism to explain this association is the combination of intense emotional suffering and cognitive impairment which may motivate impulsive behaviour in psychotic depression (Papers 1 and 2). Depressed mood including overvalued ideas and delusions of self-blame and guilt predicted suicide the first following week after admission (Paper 4).
The association of intense affective states with both imminent and long-term suicide risk factors was supported by patient experiences of sleeplessness and intense anxiety as warning signs for suicidal behaviour (Paper 1 and 2). In further support of this, depression severity assessed by the Health of the Nation Scale item 7 predicted suicide the first following week after admission (Paper 4). We found higher short-term suicide rates in patients diagnosed with psychotic depression as compared to those without psychotic symptoms at all follow-up points (Paper 3). A diagnosis of psychotic depression and depression severity assessed by MADRS depression scale as independent predictors of suicide provided knowledge on the long-term perspective (median 5.5 years follow-up).
Also of clinical importance is our finding that self-report of suicidal ideation is not a good measure of imminent, short- or long-term suicide risk. Our qualitative findings indicate that shame, psychotically motivated paranoid ideation and impulsivity motivated underreporting of both suicidal ideation and psychotic symptoms in themselves. This may partly explain why, despite reporting less suicidal ideation/planning on admission, the suicide rate was higher for patients with psychotic symptoms on admission than for those without such symptoms (Paper 3). Although reported suicidal ideation was less relevant for clinical risk assessment, paper 3 and 4 identified male gender and recent suicide attempt as significant risk factors for completed suicide.
The last main finding was that patients found both security measures and a treatment approach focusing on modifying psychotic experiences, intense anxiety and sleeplessness was helpful during hospitalization. Taking the time to talk to establish good patient relations is essential for optimal treatment conditions.
Conclusions
The periods of acute inpatient treatment and immediately post- discharge are associated with the highest suicide risk. High symptom load as well as a diagnosis of psychotic depression, especially the presence of overvalued ideas and delusions of self-blame and guilt, appear to indicate especially high suicide risk regardless of time horizon. Identifying delusions and other psychotic symptoms is thus of the utmost importance. Psychosis- and depression-focused interventions and treatment approaches aiming specifically to reduce both psychotic and affective symptom load may act as a suicide prevention strategy for psychotic depressed patients.
We found self-report of suicidal ideation of limited relevance when assessing suicide risk. Such assessments should thus always be combined with thorough clinical assessment by trained staff. This is especially true when assessing patients with psychotic depression, but especially given the frequent underreporting of psychotic symptoms, it remains important with any patient admitted for a depressive episode. Structured depression rating scales for clinician use may meaningfully contribute to suicide risk assessments. When assessing acute admission patients, we recommend paying particularly close attention to males, and patients with prior and recent suicide attempts.
References
World Health Organization. International classification of diseases for mortality and morbidity statistics (11th Revision). 2018.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. American Psychiatric Publishing; 2013.
https://doi.org/10.1176/appi.books.9780890425596
Goodwin FK, Jamison KR, Ghaemi SN. Manic-depressive illness: bipolar disorders and recurrent depression. vol p 267. Oxford University Press; 2007.
Miller JN, Black DW. Bipolar Disorder and Suicide: a Review. Current psychiatry reports. 2020/01/18 2020;22(2):6.
https://doi.org/10.1007/s11920-020-1130-0
Hasin DS, Sarvet AL, Meyers JL, et al. Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States. JAMA Psychiatry. Apr 1 2018;75(4):336-346.
https://doi.org/10.1001/jamapsychiatry.2017.4602
World Health Organization. https://www.who.int/news-room/factsheets/detail/depression. 2021;
Cavanagh J, Carson A, Sharpe M, Lawrie S. Psychological autopsy studies of suicide: a systematic review. Psychological Medicine. 2003;33(3):395-405.
https://doi.org/10.1017/S0033291702006943
Mann JJ, Apter A, Bertolote J, et al. Suicide Prevention Strategies. JAMA: The Journal of the American Medical Association. October 26, 2005 2005;294(16):2064-2074.
https://doi.org/10.1001/jama.294.16.2064
Isometsä ET. Suicides in Mood Disorders in Psychiatric Settings in Nordic National Register-Based Studies. Frontiers in psychiatry. 2020;11:721.
https://doi.org/10.3389/fpsyt.2020.00721
Shevlin M, McElroy E, Bentall RP, Reininghaus U, Murphy J. The Psychosis Continuum: Testing a Bifactor Model of Psychosis in a General Population Sample. Schizophr Bull. Jan 2017;43(1):133-141.
https://doi.org/10.1093/schbul/sbw067
Møller P, Husby R. The initial prodrome in schizophrenia: Searching for naturalistic core dimensions of experience and behavior. Schizophrenia bulletin. 2000;26(1):217.
https://doi.org/10.1093/oxfordjournals.schbul.a033442
Parnas J, Handest P. Phenomenology of anomalous self-experience in early schizophrenia. Comprehensive psychiatry. 2003;44(2):121-134.
https://doi.org/10.1053/comp.2003.50017
World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization; 1992.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR®. Washington, DC: American Psychiatric Publishing; 2000.
Gournellis R, Efstathiou V, Yotsidi V, et al. Guilt delusional beliefs increase the risk of suicidal attempt in elderly unipolar psychotic depressives. The Journal of nervous and mental disease. 2019;207(1):29-33.
https://doi.org/10.1097/NMD.0000000000000913
Nelson JC, Bickford D, Delucchi K, Fiedorowicz JG, Coryell WH. Risk of Psychosis in Recurrent Episodes of Psychotic and Nonpsychotic Major Depressive Disorder: A Systematic Review and Meta-Analysis. Am J Psychiatry. Sep 1 2018;175(9):897-904.
https://doi.org/10.1176/appi.ajp.2018.17101138
Dubovsky SL, Ghosh BM, Serotte JC, Cranwell V. Psychotic Depression: Diagnosis, Differential Diagnosis, and Treatment. Psychotherapy and psychosomatics. 2021;90(3):160-177.
https://doi.org/10.1159/000511348
Bassett D, Boyce P, Lyndon B, et al. Guidelines for the management of psychosis in the context of mood disorders. Schizophrenia Research. 2022/03/01/ 2022;241:187-196.
https://doi.org/10.1016/j.schres.2022.01.047
Lefteris L, Rossetos G. Psychotic (Delusional) Major Depression: New Vistas. Current Psychiatry Reviews. 2009;5(1):1-28.
https://doi.org/10.2174/157340009787315271
Zaninotto L, Guglielmo R, Calati R, et al. Cognitive markers of psychotic unipolar depression: a meta-analytic study. J Affect Disord. Mar 15 2015;174:580-8.
https://doi.org/10.1016/j.jad.2014.11.027
Fleming SK, Blasey C, Schatzberg AF. Neuropsychological correlates of psychotic features in major depressive disorders: a review and meta-analysis. Journal of Psychiatric Research. Jan 2004;38(1):27-35.
https://doi.org/10.1016/S0022-3956(03)00100-6
Coryell W, Leon A, Winokur G, et al. Importance of psychotic features to longterm course in major depressive disorder. The American journal of psychiatry. 1996;
Vythilingam M, Chen J, Bremner JD, Mazure CM, Maciejewski PK, Nelson JC. Psychotic depression and mortality. American Journal of Psychiatry. 2003;160(3):574-576.
https://doi.org/10.1176/appi.ajp.160.3.574
Gournellis R, Tournikioti K, Touloumi G, et al. Psychotic (delusional) depression and suicidal attempts: a systematic review and meta-analysis. Acta Psychiatr Scand. Nov 26 2017
https://doi.org/10.1111/acps.12826
Zalpuri I, Rothschild AJ. Does psychosis increase the risk of suicide in patients with major depression? A systematic review. J Affect Disord. Jul 01 2016;198:23-31.
https://doi.org/10.1016/j.jad.2016.03.035
Rothschild AJ, Winer J, Flint AJ, et al. Missed diagnosis of psychotic depression at 4 academic medical centers. J Clin Psychiatry. Aug 2008;69(8):1293-6.
https://doi.org/10.4088/JCP.v69n0813
Rothschild AJ. Clinical manual for diagnosis and treatment of psychotic depression. American Psychiatric Publishing, Inc.; 2009.
Caldieraro MA, Dufour S, Sylvia LG, et al. Treatment outcomes of acute bipolar depressive episode with psychosis. Depression and anxiety. 2018;35(5):402-410.
https://doi.org/10.1002/da.22716
Fountoulakis KN, Yatham L, Grunze H, et al. The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 2: Review, Grading of the Evidence, and a Precise Algorithm. The international journal of neuropsychopharmacology. Feb 1 2017;20(2):121-179.
https://doi.org/10.1093/ijnp/pyw100
Frankland A, Cerrillo E, Hadzi-Pavlovic D, et al. Comparing the phenomenology of depressive episodes in bipolar I and II disorder and major depressive disorder within bipolar disorder pedigrees. J Clin Psychiatry. Jan 2015;76(1):32-8; quiz 39.
https://doi.org/10.4088/JCP.14m09293
Goes FS, Sadler B, Toolan J, et al. Psychotic features in bipolar and unipolar depression. Bipolar Disord. Dec 2007;9(8):901-6.
https://doi.org/10.1111/j.1399-5618.2007.00460.x
Kessing LV. Severity of depressive episodes during the course of depressive disorder. The British Journal of Psychiatry. 2008;192(4):290-293.
https://doi.org/10.1192/bjp.bp.107.038935
Rothschild AJ. Psychotic depression and suicide. Acta Psychiatr Scand. Apr 2018;137(4):364-365.
https://doi.org/10.1111/acps.12864
Kruizinga J, Liemburg E, Burger H, et al. Pharmacological treatment for psychotic depression. Cochrane Database of Systematic Reviews. 2021;(12)
https://doi.org/10.1002/14651858.CD004044.pub5
Kjelby E, Jørgensen HA, Kroken RA, Løberg E-M, Johnsen E. Anti-depressive effectiveness of olanzapine, quetiapine, risperidone and ziprasidone: a pragmatic, randomized trial. BMC Psychiatry. 2011/08/31 2011;11(1):145.
https://doi.org/10.1186/1471-244X-11-145
Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar disorders. 2013;15(1):1-44.
https://doi.org/10.1111/bdi.12025
Naghavi M. Global burden of disease self-harm collaborators: global, regional, and national burden of suicide mortality 1990 to 2016: systematic analysis for the global burden of disease study 2016. BMJ. 2019;364(l94)
https://doi.org/10.1136/bmj.l94
World Health Organization. Suicide in the world. https://appswhoint/iris/bitstream/handle/10665/326948/WHO-MSD-MER-193-engpdf. 2019;
World Health Organisation. https://wwwwhoint/news-room/factsheets/detail/suicide. 2019;
Global Change Data Lab. Our world in data. https://ourworldindataorg/grapher/suicide-death-rate-by-age?country=~OWID_WRL.
Hjorthoj CR, Madsen T, Agerbo E, Nordentoft M. Risk of suicide according to level of psychiatric treatment: a nationwide nested case-control study. Soc Psychiatry Psychiatr Epidemiol. Sep 2014;49(9):1357-65.
https://doi.org/10.1007/s00127-014-0860-x
Madsen T, Erlangsen A, Nordentoft M. Risk Estimates and Risk Factors Related to Psychiatric Inpatient Suicide-An Overview. International journal of environmental research and public health. Mar 2 2017;14(3)
https://doi.org/10.3390/ijerph14030253
Nock M. Self-Injury. Annual review of clinical psychology. 03/01 2010;6:342.
https://doi.org/10.1146/annurev.clinpsy.121208.131258
World Health Organization. Suicide prevention (SUPRE). http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/#
Camus A. Sisyfos-myten. Gyldendal; 2018.
Gunnell D, Frankel S. Prevention of suicide: aspirations and evidence. Bmj. 1994;308(6938):1227-1233.
https://doi.org/10.1136/bmj.308.6938.1227
Sisti DA, Joffe S. Implications of Zero Suicide for Suicide Prevention Research. JAMA. 2018;320(16):1633-1634.
https://doi.org/10.1001/jama.2018.13083
Shneidman ES. Suicide as psychache: A clinical approach to self-destructive behavior. Jason Aronson; 1993.
https://doi.org/10.1097/00005053-199303000-00001
Rasmussen ML, Dieserud G, Dyregrov K, Haavind H. Warning signs of suicide among young men. Nordic Psychology. 2014/07/03 2014;66(3):153-167.
https://doi.org/10.1080/19012276.2014.921576
Voros V, Tenyi T, Nagy A, Fekete S, Osvath P. Crisis Concept Re-loaded?-The Recently Described Suicide-Specific Syndromes May Help to Better Understand Suicidal Behavior and Assess Imminent Suicide Risk More Effectively. Conceptual Analysis. Frontiers in psychiatry. 2021-March-24 2021;12(312)
https://doi.org/10.3389/fpsyt.2021.598923
Rihmer Z. Strategies of suicide prevention: Focus on health care. Journal of Affective Disorders. 1996/07/08/ 1996;39(2):83-91.
https://doi.org/10.1016/0165-0327(96)00007-9
Mellesdal L, Mehlum L, Wentzel-Larsen T, Kroken R, Jorgensen HA. Suicide risk and acute psychiatric readmissions: a prospective cohort study. Psychiatric services (Washington, DC). Jan 2010;61(1):25-31.
https://doi.org/10.1176/appi.ps.61.1.25
Chung DT, Ryan CJ, Hadzi-Pavlovic D, Singh SP, Stanton C, Large MM. Suicide Rates After Discharge From Psychiatric Facilities: A Systematic Review and Metaanalysis. JAMA Psychiatry. Jul 1 2017;74(7):694-702.
https://doi.org/10.1001/jamapsychiatry.2017.1044
Walsh G, Sara G, Ryan CJ, Large M. Meta-analysis of suicide rates among psychiatric in-patients. Acta Psychiatr Scand. Mar 2015;131(3):174-84.
https://doi.org/10.1111/acps.12383
Franklin JC, Ribeiro JD, Fox KR, et al. Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychol Bull. Feb 2017;143(2):187-232.
https://doi.org/10.1037/bul0000084
Madsen T, Erlangsen A, Hjorthøj C, Nordentoft M. High suicide rates during psychiatric inpatient stay and shortly after discharge. Acta Psychiatr Scand. Jul 26 2020
https://doi.org/10.1111/acps.13221
Olfson M, Wall M, Wang S, et al. Short-term Suicide Risk After Psychiatric Hospital Discharge. JAMA Psychiatry. 2016;73(11):1119-1126.
https://doi.org/10.1001/jamapsychiatry.2016.2035
Deisenhammer EA, Behrndt E-M, Kemmler G, Haring C, Miller C. Suicide Risk Factors in Patients Recently Discharged From a Psychiatric Hospital: A Case-Control Study. J Clin Psychiatry. 2019;80(5).
https://doi.org/10.4088/JCP.18m12702
Walby FA, Myhre MO, Kildahl AT. Contact With Mental Health Services Prior to Suicide: A Systematic Review and Meta-Analysis. Psychiatric services (Washington, DC). Jul 1 2018;69(7):751-759.
https://doi.org/10.1176/appi.ps.201700475
Prestmo A, Høyen K, Vaaler AE, Torgersen T, Drange OK. Mortality Among Patients Discharged From an Acute Psychiatric Department: A 5-Year Prospective Study. Frontiers in psychiatry. 2020;11:816.
https://doi.org/10.3389/fpsyt.2020.00816
Nordentoft M, Erlangsen A, Madsen T. Postdischarge suicides: nightmare and disgrace. JAMA psychiatry. 2016;73(11):1113-1114.
https://doi.org/10.1001/jamapsychiatry.2016.2010
Bolton JM. Suicide risk assessment in the emergency department: out of the darkness. Depress Anxiety. Feb 2015;32(2):73-5.
https://doi.org/10.1002/da.22320
Strømme MF, Mellesdal LS, Bartz-Johannesen C, et al. Mortality and non-use of antipsychotic drugs after acute admission in schizophrenia: A prospective totalcohort study. Schizophr Res. Jul 21 2021;235:29-35.
https://doi.org/10.1016/j.schres.2021.07.009
Fredriksen K, Mellesdal L, Gjestad R, et al. High scores on the MADRS depression rating scale and psychotic symptoms predict suicide: -A prospective cohort study of psychiatric acute ward patients. manuscript accepted J Clin Psychiatry. 2022;
https://doi.org/10.4088/JCP.21m14018
Kroken RA, Kjelby E, Wentzel-Larsen T, Mellesdal LS, Jørgensen HA, Johnsen E. Time to discontinuation of antipsychotic drugs in a schizophrenia cohort: influence of current treatment strategies. J Therapeutic advances in psychopharmacology. 2014;4(6):228-239.
https://doi.org/10.1177/2045125314545614
Fosse R, Ryberg W, Carlsson MK, Hammer J. Predictors of suicide in the patient population admitted to a locked-door psychiatric acute ward. PloS one. 2017;12(3):e0173958.
https://doi.org/10.1371/journal.pone.0173958
Bjureberg J, Dahlin M, Carlborg A, Edberg H, Haglund A, Runeson B. Columbia-Suicide Severity Rating Scale Screen Version: initial screening for suicide risk in a psychiatric emergency department. Psychol Med. Mar 26 2021:1-9.
https://doi.org/10.1017/S0033291721000751
Aaltonen KI, Isometsa E, Sund R, Pirkola S. Risk factors for suicide in depression in Finland: first-hospitalized patients followed up to 24 years. Acta Psychiatr Scand. Nov 27 2018
https://doi.org/10.1111/acps.12990
Fawcett J, Scheftner WA, Fogg L, et al. Time-related predictors of suicide in major affective disorder. The American Journal of Psychiatry. 1990;147(9):1189-1194.
https://doi.org/10.1176/ajp.147.9.1189
Leadholm AK, Rothschild AJ, Nielsen J, Bech P, Ostergaard SD. Risk factors for suicide among 34,671 patients with psychotic and non-psychotic severe depression. Journal of Affective Disorders. Mar 2014;156:119-25.
https://doi.org/10.1016/j.jad.2013.12.003
Large M, Smith G, Sharma S, Nielssen O, Singh SP. Systematic review and meta-analysis of the clinical factors associated with the suicide of psychiatric inpatients. Acta Psychiatr Scand. Jul 2011;124(1):18-29.
https://doi.org/10.1111/j.1600-0447.2010.01672.x
Hawton K, i Comabella CC, Haw C, Saunders KJJoad. Risk factors for suicide in individuals with depression: a systematic review. Journal of Affective Disorders. 2013;147(1-3):17-28.
https://doi.org/10.1016/j.jad.2013.01.004
Lin S-K, Hung T-M, Liao Y-T, et al. Protective and risk factors for inpatient suicides: A nested case-control study. Psychiatry Research. 2014/06/30/ 2014;217(1):54-59.
https://doi.org/10.1016/j.psychres.2014.03.008
Steblaj A, Tavcar R, Dernovsek MZ. Predictors of suicide in psychiatric hospital. Acta Psychiatr Scand. Nov 1999;100(5):383-8.
https://doi.org/10.1111/j.1600-0447.1999.tb10882.x
King EA, Baldwin DS, Sinclair JM, Campbell MJ. The Wessex Recent In-Patient Suicide Study, 2. Case-control study of 59 in-patient suicides. The British journal of psychiatry : the journal of mental science. Jun 2001;178:537-42.
https://doi.org/10.1192/bjp.178.6.537
Hunt IM, Kapur N, Webb R, et al. Suicide in current psychiatric in-patients: a case-control study The National Confidential Inquiry into Suicide and Homicide. Psychol Med. Jun 2007;37(6):831-7.
https://doi.org/10.1017/S0033291707000104
Dong JY, Ho TP, Kan CK. A case-control study of 92 cases of in-patient suicides. J Affect Disord. Jul 2005;87(1):91-9.
https://doi.org/10.1016/j.jad.2005.03.015
Taiminen TJ, Kujari H. Antipsychotic medication and suicide risk among schizophrenic and paranoid inpatients. A controlled retrospective study. Acta Psychiatr Scand. Oct 1994;90(4):247-51.
https://doi.org/10.1111/j.1600-0447.1994.tb01588.x
Powell J, Geddes J, Deeks J, Goldacre M, Hawton K. Suicide in psychiatric hospital in-patients. Risk factors and their predictive power. The British journal of psychiatry : the journal of mental science. Mar 2000;176:266-72.
https://doi.org/10.1192/bjp.176.3.266
Mann J, Michel C, Auerbach R. Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review. Am J Psychiatry 2021;178(7):611-624.
https://doi.org/10.1176/appi.ajp.2020.20060864
Runeson B, Odeberg J, Pettersson A, Edbom T, Adamsson IJ, Waern M. Instruments for the assessment of suicide risk: A systematic review evaluating the certainty of the evidence. PloS one. 2017;12(7):e0180292.
https://doi.org/10.1371/journal.pone.0180292
Roos L, Sareen J, Bolton JM. Suicide risk assessment tools, predictive validity findings and utility today: time for a revamp? Neuropsychiatry. 2013;3(5):483.
https://doi.org/10.2217/npy.13.60
Radomsky ED, Haas GL, Mann JJ, Sweeney JA. Suicidal behavior in patients with schizophrenia and other psychotic disorders. American journal of psychiatry. 1999;156(10):1590-1595.
https://doi.org/10.1176/ajp.156.10.1590
Sani G, Tondo L, Koukopoulos A, et al. Suicide in a large population of former psychiatric inpatients. Psychiatry and clinical neurosciences. 2011;65(3):286-295.
https://doi.org/10.1111/j.1440-1819.2011.02205.x
DeVylder JE, Lukens EP, Link BG, Lieberman JA. Suicidal ideation and suicide attempts among adults with psychotic experiences: data from the Collaborative Psychiatric Epidemiology Surveys. JAMA psychiatry. 2015;72(3):219-225.
https://doi.org/10.1001/jamapsychiatry.2014.2663
Villa J, Ehret BC, Depp CA. Systematic Review of the Inclusion of People With Psychosis in Suicide-Specific Clinical Trials. Crisis. May 2020;41(3):233-236.
https://doi.org/10.1027/0227-5910/a000628
Yates K, Lång U, Cederlöf M, et al. Association of Psychotic Experiences With Subsequent Risk of Suicidal Ideation, Suicide Attempts, and Suicide Deaths: A Systematic Review and Meta-analysis of Longitudinal Population Studies. JAMA Psychiatry. Feb 1 2019;76(2):180-189.
https://doi.org/10.1001/jamapsychiatry.2018.3514
Roose SP. Depression, delusions, and suicide. The American journal of psychiatry. 1983;
Isometsa E, Sund R, Pirkola S. Post-discharge suicides of inpatients with bipolar disorder in Finland. Bipolar Disord. Dec 2014;16(8):867-74.
https://doi.org/10.1111/bdi.12237
Gournellis R, Tournikioti K, Touloumi G, et al. Psychotic (delusional) depression and completed suicide: a systematic review and meta-analysis. journal article. Annals of General Psychiatry. September 21 2018;17(1):39.
https://doi.org/10.1186/s12991-018-0207-1
Suominen K, Haukka J, Valtonen HM, Lonnqvist J. Outcome of patients with major depressive disorder after serious suicide attempt. J Clin Psychiatry. Oct 2009;70(10):1372-8.
https://doi.org/10.4088/JCP.09m05110blu
Kuperberg M, Katz D, Greenebaum SLA, et al. Psychotic symptoms during bipolar depressive episodes and suicidal ideation. Journal of Affective Disorders. 2021/03/01/ 2021;282:1241-1246.
https://doi.org/10.1016/j.jad.2020.12.184
Maina G, Quarato F, Bramante S. Risk factors for suicide in bipolar disorder. Further exploration of suicidal behavior. 2019;25:149-154.
Robinson DG, Spiker DG. Delusional depression. A one year follow-up. J Affect Disord. Jul 1985;9(1):79-83. doi:10.1016/0165-0327(85)90013-8
https://doi.org/10.1016/0165-0327(85)90013-8
Wolfersdorf M, Keller F, Steiner B, Hole GJAPS. Delusional depression and suicide. 1987;76(4):359-363.
https://doi.org/10.1111/j.1600-0447.1987.tb05619.x
Glenn CR, Nock MK. Improving the short-term prediction of suicidal behavior. American journal of preventive medicine. Sep 2014;47(3 Suppl 2):S176-80.
https://doi.org/10.1016/j.amepre.2014.06.004
Schnyder U, Valach L, Bichsel K, Michel K. Attempted suicide. Do we understand the patients' reasons? Gen Hosp Psychiatry. Jan-Feb 1999;21(1):62-9.
https://doi.org/10.1016/S0163-8343(98)00064-4
Pavulans KS, Bolmsjo I, Edberg AK, Ojehagen A. Being in want of control: Experiences of being on the road to, and making, a suicide attempt. International journal of qualitative studies on health and well-being. 2012;7
https://doi.org/10.3402/qhw.v7i0.16228
Thorvik A. Suicid som etisk fenomen: teoretiske og empiriske perspektiver. 2011;
Bolton JM, Gunnell D, Turecki G. Suicide risk assessment and intervention in people with mental illness. BMJ. 2015;351:h4978.
https://doi.org/10.1136/bmj.h4978
Large M, Kaneson M, Myles N, Myles H, Gunaratne P, Ryan C. Meta-Analysis of Longitudinal Cohort Studies of Suicide Risk Assessment among Psychiatric Patients: Heterogeneity in Results and Lack of Improvement over Time. PloS one. 2016;11(6):e0156322.
https://doi.org/10.1371/journal.pone.0156322
Chan MK, Bhatti H, Meader N, et al. Predicting suicide following self-harm: systematic review of risk factors and risk scales. The British journal of psychiatry : the journal of mental science. Oct 2016;209(4):277-283.
https://doi.org/10.1192/bjp.bp.115.170050
Lindh AU, Dahlin M, Beckman K, et al. A Comparison of Suicide Risk Scales in Predicting Repeat Suicide Attempt and Suicide: A Clinical Cohort Study. J Clin Psychiatry. Nov 19 2019;80(6)
https://doi.org/10.4088/JCP.18m12707
Rudd MD. Suicide warning signs in clinical practice. Current Psychiatry Reports Feb 2008;10(1):87-90.
https://doi.org/10.1007/s11920-008-0015-4
Busch KA, Fawcett J, Jacobs DG. Clinical correlates of inpatient suicide. J Clin Psychiatry. 2003;64(1):14-19.
https://doi.org/10.4088/JCP.v64n0105
Berman AL. Risk Factors Proximate to Suicide and Suicide Risk Assessment in the Context of Denied Suicide Ideation. Suicide Life Threat Behav. Jun 2018;48(3):340-352.
https://doi.org/10.1111/sltb.12351
Pigeon WR, Pinquart M, Conner K. Meta-analysis of sleep disturbance and suicidal thoughts and behaviors. J Clin Psychiatry. Sep 2012;73(9):e1160-7.
https://doi.org/10.4088/JCP.11r07586
Bernert RA, Kim JS, Iwata NG, Perlis ML. Sleep disturbances as an evidencebased suicide risk factor. Current psychiatry reports. Mar 2015;17(3):554.
https://doi.org/10.1007/s11920-015-0554-4
Britton PC, Ilgen MA, Rudd MD, Conner KR. Warning signs for suicide within a week of healthcare contact in Veteran decedents. J Psychiatry Research. 2012;200(2-3):395-399.
https://doi.org/10.1016/j.psychres.2012.06.036
Gvion Y, Apter A. Aggression, impulsivity, and suicide behavior: a review of the literature. Archives of Suicide Research. 2011;15(2):93-112.
https://doi.org/10.1080/13811118.2011.565265
Fawcett J, Scheftner WA, Fogg L, Clark DC. Time-related predictors of suicide in major affective disorder. The American Journal of Psychiatry. 1990;
Hendin H, Maltsberger JT, Szanto K. The role of intense affective states in signaling a suicide crisis. J Nerv Ment Dis. May 2007;195(5):363-8.
https://doi.org/10.1097/NMD.0b013e318052264d
Runeson BS, Beskow J, Waern M. The suicidal process in suicides among young people. Acta Psychiatrica Scandinavica. 1996;93(1):35-42.
https://doi.org/10.1111/j.1600-0447.1996.tb10616.x
van Heeringen K, Hawton K, Williams G, Mark J. Pathways to suicide: an integrative approach. The international handbook of suicide and attempted suicide. 2008:223-234.
https://doi.org/10.1002/9780470698976.ch14
Post RM. Transduction of Psychosocial Stress Into the Neurobiology. Am J Psychiatry. 1992;149:999-1010.
https://doi.org/10.1176/ajp.149.8.999
Segal ZV, Williams J, Teasdale J, Gemar M. A cognitive science perspective on kindling and episode sensitization in recurrent affective disorder. Psychological Medicine. 1996;26(2):371-380.
https://doi.org/10.1017/S0033291700034760
Williams JMG, Williams M. Suicide and attempted suicide: Understanding the cry of pain. Mark Williams; 2001.
Bloch-Elkouby S, Barzilay S, Gorman B, et al. The Revised Suicide Crisis Inventory (SCI-2): Validation and Assessment of Prospective Suicidal Outcomes at One Month Follow-Up. J Affect Disord. 2021/08/27/ 2021
https://doi.org/10.1016/j.jad.2021.08.048
Galynker I. The suicidal crisis: clinical guide to the assessment of imminent suicide risk. Oxford University Press; 2017.
https://doi.org/10.1093/med/9780190260859.001.0001
Schuck A, Calati R, Barzilay S, Bloch-Elkouby S, Galynker I. Suicide Crisis Syndrome: A review of supporting evidence for a new suicide-specific diagnosis. Behavioral sciences & the law. May 2019;37(3):223-239.
https://doi.org/10.1002/bsl.2397
Vaaler AE. Benzodiazepines in emergency psychiatric treatment. Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke. May 7 2019;139(8)Benzodiazepiner i akuttpsykiatrisk behandling.
https://doi.org/10.4045/tidsskr.19.0228
Zealberg JJ, Brady KT. Substance abuse and emergency psychiatry. Psychiatr Clin North Am. Dec 1999;22(4):803-17.
https://doi.org/10.1016/S0193-953X(05)70127-1
Allen MH, Currier GW, Hughes DH, Docherty JP, Carpenter D, Ross R. Treatment of behavioral emergencies: a summary of the expert consensus guidelines. J Psychiatr Pract. Jan 2003;9(1):16-38.
https://doi.org/10.1097/00131746-200301000-00004
Nock MK, Borges G, Bromet EJ, et al. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. The British journal of psychiatry : the journal of mental science. Feb 2008;192(2):98-105.
https://doi.org/10.1192/bjp.bp.107.040113
Klonsky ED, May AM, Saffer BY. Suicide, Suicide Attempts, and Suicidal Ideation. Annual Review of Clinical Psychology. 2016;12(1):307-330.
https://doi.org/10.1146/annurev-clinpsy-021815-093204
Chapman CL, Mullin K, Ryan CJ, Kuffel A, Nielssen O, Large MM. Meta-analysis of the association between suicidal ideation and later suicide among patients with either a schizophrenia spectrum psychosis or a mood disorder. Acta Psychiatr Scand. Mar 2015;131(3):162-73.
https://doi.org/10.1111/acps.12359
Hubers AAM, Moaddine S, Peersmann SHM, et al. Suicidal ideation and subsequent completed suicide in both psychiatric and non-psychiatric populations: a meta-analysis. Epidemiology and psychiatric sciences. Apr 2018;27(2):186-198.
https://doi.org/10.1017/S2045796016001049
McHugh CM, Corderoy A, Ryan CJ, Hickie IB, Large MM. Association between suicidal ideation and suicide: meta-analyses of odds ratios, sensitivity, specificity and positive predictive value. BJPsych open. Mar 2019;5(2):e18.
https://doi.org/10.1192/bjo.2018.88
Klonsky ED, Victor SE, Saffer BY. Nonsuicidal self-injury: what we know, and what we need to know. Canadian journal of psychiatry Revue canadienne de psychiatrie. 2014;59(11):565-568.
https://doi.org/10.1177/070674371405901101
Sher L. Suicide in men: the time is ripe for active scientific investigations. Acta Psychiatrica Scandinavica. 2018;137(4):275-276.
https://doi.org/10.1111/acps.12861
Rutz W, Rihmer Z. Suicidality in men - practical issues, challenges, solutions. The Journal of Men's Health & Gender. 2007;4(4):393-401.
https://doi.org/10.1016/j.jmhg.2007.07.046
Brent DA, Oquendo MA, Reynolds CF, 3rd. Caring for Suicidal Patients. JAMA Psychiatry. Aug 1 2019;76(8):862-863.
https://doi.org/10.1001/jamapsychiatry.2019.0927
Baldessarini RJ, Tondo L, Davis P, Pompili M, Goodwin FK, Hennen J. Decreased risk of suicides and attempts during long term lithium treatment: a meta analytic review. Bipolar disorders. 2006;8(5p2):625-639.
https://doi.org/10.1111/j.1399-5618.2006.00344.x
Cipriani A, Pretty H, Hawton K, Geddes JR. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. American Journal of Psychiatry. 2005;162(10):1805-1819.
https://doi.org/10.1176/appi.ajp.162.10.1805
Reeves H, Batra S, May RS, Zhang R, Dahl DC, Li X. Efficacy of risperidone augmentation to antidepressants in the management of suicidality in major depressive disorder: a randomized, double-blind, placebo-controlled pilot study. J Clin Psychiatry. Aug 2008;69(8):1228-336.
https://doi.org/10.4088/JCP.v69n0805
Sharma T, Guski LS, Freund N, Gøtzsche PC. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ. 2016;352:i65.
https://doi.org/10.1136/bmj.i65
DiazGranados N, Ibrahim L, Brutsche N, et al. Rapid Resolution of Suicidal Ideation after a Single Infusion of an NMDA Antagonist in Patients with Treatment- Resistant Major Depressive Disorder. The Journal of clinical psychiatry. 07/13 2010;71(12):1605-1611.
https://doi.org/10.4088/JCP.09m05327blu
Gaertner I, Gilot C, Heidrich P, Gaertner HJ. A case control study on psychopharmacotherapy before suicide committed by 61 psychiatric inpatients. Pharmacopsychiatry. Mar 2002;35(2):37-43.
https://doi.org/10.1055/s-2002-25027
Garriga M, Pacchiarotti I, Kasper S, et al. Assessment and management of agitation in psychiatry: Expert consensus. The World Journal of Biological Psychiatry. 2016/02/17 2016;17(2):86-128.
https://doi.org/10.3109/15622975.2015.1132007
Wilkinson ST, Ballard ED, Bloch MH, et al. The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review and Individual Participant Data Meta-Analysis. Am J Psychiatry. Feb 1 2018;175(2):150-158.
https://doi.org/10.1176/appi.ajp.2017.17040472
Witt K, Potts J, Hubers A, et al. Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta-analysis of treatment trials. The Australian and New Zealand journal of psychiatry. Jan 2020;54(1):29-45.
https://doi.org/10.1177/0004867419883341
Kellner CH, Li EH, Farber KG, Geduldig ET, Ahle GM. Electroconvulsive Therapy (ECT) and Suicide Prevention. Current Treatment Options in Psychiatry. 2016// 2016;3(1):73-81.
https://doi.org/10.1007/s40501-016-0067-8
Hawton K, Heeringen K. The International Handbook of Suicide and Attempted Suicide, pp.585-595. Wiley Online Library; 2000.
https://doi.org/10.1002/9780470698976
Lakeman R, FitzGerald M. How people live with or get over being suicidal: a review of qualitative studies. Journal of advanced nursing. 2008;64(2):114-126.
https://doi.org/10.1111/j.1365-2648.2008.04773.x
Bjornestad J, Davidson L, Joa I, et al. Antipsychotic treatment: experiences of fully recovered service users. Journal of mental health (Abingdon, England). Jun 2017;26(3):264-270.
https://doi.org/10.1080/09638237.2017.1294735
Bjornestad J, Hegelstad WTV, Joa I, et al. "With a little help from my friends" social predictors of clinical recovery in first-episode psychosis. Psychiatry Res. May 30 2017;255:209-214.
https://doi.org/10.1016/j.psychres.2017.05.041
Berg SH, Rortveit K, Walby FA, Aase K. Safe clinical practice for patients hospitalised in a suicidal crisis: a study protocol for a qualitative case study. BMJ open. Jan 27 2020;7(1):e012874.
https://doi.org/10.1136/bmjopen-2016-012874
Berg SH, Rortveit K, Aase K. Suicidal patients' experiences regarding their safety during psychiatric in-patient care: a systematic review of qualitative studies. BMC health services research. Jan 23 2017;17(1):73.
https://doi.org/10.1186/s12913-017-2023-8
Biddle L, Donovan J, Owen-Smith A, et al. Factors influencing the decision to use hanging as a method of suicide: qualitative study. The British journal of psychiatry : the journal of mental science. Oct 2010;197(4):320-5.
https://doi.org/10.1192/bjp.bp.109.076349
University of Manchester. The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness 2016;
Watts BV, Young-Xu Y, Mills PD, et al. Examination of the effectiveness of the Mental Health Environment of Care Checklist in reducing suicide on inpatient mental health units. Arch Gen Psychiatry. Jun 2012;69(6):588-92.
https://doi.org/10.1001/archgenpsychiatry.2011.1514
van der Merwe M, Bowers L, Jones J, Simpson A, Haglund K. Locked doors in acute inpatient psychiatry: a literature review. Journal of psychiatric and mental health nursing. 2009;16(3):293-299.
https://doi.org/10.1111/j.1365-2850.2008.01378.x
Huber CG, Schneeberger AR, Kowalinski E, et al. Suicide risk and absconding in psychiatric hospitals with and without open door policies: a 15 year, observational study. The lancet Psychiatry. Sep 2016;3(9):842-9.
https://doi.org/10.1016/S2215-0366(16)30168-7
Malterud K. The art and science of clinical knowledge: evidence beyond measures and numbers. Lancet. Aug 4 2001;358(9279):397-400.
https://doi.org/10.1016/S0140-6736(01)05548-9
Malterud K. Qualitative research: standards, challenges, and guidelines. The Lancet. 2001;358(9280):483-488.
https://doi.org/10.1016/S0140-6736(01)05627-6
Malterud K. Kvalitative metoder i medisinsk forskning: en innføring. Universitetsforlaget; 2011.
Gadamer H-G. The enigma of health: The art of healing in a scientific age. John Wiley & Sons; 2018.
Malterud K. Systematic text condensation: A strategy for qualitative analysis. Scandinavian Journal of Public Health. 2012;40(8):795-805.
https://doi.org/10.1177/1403494812465030
Miller WL, Crabtree BF. Doing qualitative research. vol 3. Thousand Oaks, California: Sage publications Inc; 1999.
Malterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qualitative Health Research. Nov 27 2015;Vol. 26(13):1753-1760.
https://doi.org/10.1177/1049732315617444
Mann C. Observational research methods. Research design II: cohort, cross sectional, and case-control studies. Emergency medicine journal. 2003;20(1):54-60.
https://doi.org/10.1136/emj.20.1.54
FHI. https://wwwfhino/nettpub/hin/psykisk-helse/selvmord-i-norge. 2021;
American Psychiatric Association. Diagnostic criteria from DSM-IV. Amer Psychiatric Pub Inc; 1994.
First M, Spitzer R, Gibbon M, Williams J. Structured Clinical Interview for DSMIV Axis I Disorders, Patient Edition (SCID-P). New York, NY, New York State Psychiatric Institute, Biometrics Research Department. 1996;
https://doi.org/10.1037/t07827-000
Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia bulletin. 1987;13(2):261-276.
https://doi.org/10.1093/schbul/13.2.261
Weibell MA, Joa I, Bramness J, et al. Treated incidence and baseline characteristics of substance induced psychosis in a Norwegian catchment area. BMC Psychiatry. 2013;13:319.
https://doi.org/10.1186/1471-244X-13-319
Mellesdal L, Kroken RA, Lutro O, et al. Self-harm induced somatic admission after discharge from psychiatric hospital - a prospective cohort study. European psychiatry : the journal of the Association of European Psychiatrists. May 2014;29(4):246-52.
https://doi.org/10.1016/j.eurpsy.2013.06.006
Müller MJ, Himmerich H, Kienzle B, Szegedi A. Differentiating moderate and severe depression using the Montgomery-Åsberg depression rating scale (MADRS). Journal of Affective Disorders. 2003/12/01/ 2003;77(3):255-260.
https://doi.org/10.1016/S0165-0327(02)00120-9
Williams JBW, Kobak KA. Development and reliability of a structured interview guide for the Montgomery-Åsberg Depression Rating Scale (SIGMA). British Journal of Psychiatry. 2008;192(1):52-58.
https://doi.org/10.1192/bjp.bp.106.032532
Svanborg P, Asberg M. A comparison between the Beck Depression Inventory (BDI) and the self-rating version of the Montgomery Asberg Depression Rating Scale (MADRS). J Affect Disord. May 2001;64(2-3):203-16.
https://doi.org/10.1016/S0165-0327(00)00242-1
Wing J, Curtis R, Beevor A. 'Health of the Nation': measuring mental health outcomes. Psychiatric Bulletin. 1994;18(11):690-691.
https://doi.org/10.1192/pb.18.11.690
James M, Painter J, Buckingham B, Stewart MW. A review and update of the Health of the Nation Outcome Scales (HoNOS). BJPsych Bull. 2018;42(2):63-68.
https://doi.org/10.1192/bjb.2017.17
Pirkis JE, Burgess PM, Kirk PK, Dodson S, Coombs TJ, Williamson MK. A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures. Health Qual Life Outcomes. Nov 28 2005;3:76.
https://doi.org/10.1186/1477-7525-3-76
Wing J, Curtis RH, Beevor A. Health of the Nation Outcome Scales (HoNOS). Glossary for HoNOS score sheet. The British journal of psychiatry : the journal of mental science. May 1999;174:432-4.
https://doi.org/10.1192/bjp.174.5.432
Fankhauser S, Hochstrasser B, Sievers M, Soyka M. [Assessing Change of Depressive Symptoms and Severity of Depression in an Inpatient Setting : Performance of the HoNOS (Health of the Nation Outcome Scales)]. Psychother Psychosom Med Psychol. Sep 2017;67(9-10):391-400. Die Eignung der HoNOS (Health of the Nation Outcome Scales) zur Erfassung des Verlaufs und des Schweregrads depressiver Symptomatik im stationären Setting.
https://doi.org/10.1055/s-0043-105482
Pedersen AG, Ellingsen CL. Data quality in the Causes of Death Registry. Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke. May 5 2015;135(8):768-70.
https://doi.org/10.4045/tidsskr.14.1065
Vittinghoff E, McCulloch CE. Relaxing the Rule of Ten Events per Variable in Logistic and Cox Regression. American Journal of Epidemiology. 2006;165(6):710-718. doi:10.1093/aje/kwk052 %J American Journal of Epidemiology
https://doi.org/10.1093/aje/kwk052
R Core Team. R: A language and environment for statistical computing. . R Foundation for Statistical Computing, Vienna, Austria. 2020;
Whittemore R, Knafl K. The integrative review: updated methodology. Journal of advanced nursing. 2005;52(5):546-553.
https://doi.org/10.1111/j.1365-2648.2005.03621.x
Lakeman R, Fitzgerald M. The ethics of suicide research. Crisis. 2009;30(1):13-9.
https://doi.org/10.1027/0227-5910.30.1.13
Fisher CB, Pearson JL, Kim S, Reynolds CF. Ethical Issues in including Suicidal Individuals in Clinical Research. IRB: Ethics & Human Research. 2002;24(5):9-14.
https://doi.org/10.2307/3563804
Rothschild AJ. Challenges in the treatment of depression with psychotic features. Biological Psychiatry. Apr 15 2003;53(8):680-90.
https://doi.org/10.1016/S0006-3223(02)01747-X
Heslin M, Young AH. Psychotic major depression: challenges in clinical practice and research. The British Journal of Psychiatry. 2018;212(3):131-133.
https://doi.org/10.1192/bjp.2017.43
Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 7. Aufl New York. Oxford; 2013.
Baldwin CJJoAS. Narrative ethics for narrative care. 2015;34:183-189.
https://doi.org/10.1016/j.jaging.2015.02.014
Fredriksen KJ, Schoeyen HK, Johannessen JO, Walby FA, Davidson L, Schaufel MA. Psychotic Depression and Suicidal Behavior. Psychiatry. 2017/01/02 2017;80(1):17-29.
https://doi.org/10.1080/00332747.2016.1208002
Fredriksen KJ, Schaufel MA, Johannessen JO, Walby FA, Davidson L, Schoeyen HK. Preventing suicide among psychiatric inpatients with psychotic depression. Psychiatric Quarterly. 2020;91(1):223-236.
https://doi.org/10.1007/s11126-019-09677-6
Fredriksen K, Bartz-Johannessen C, Schoeyen H, Vaaler A, Walby FP, Hegelstad W. Imminent and very short-term risk of death by suicide in 7000 acutely admitted psychiatric inpatients. submitted, in review. 2022;
Keilp JG, Sackeim HA, Brodsky BS, Oquendo MA, Malone KM, Mann JJ. Neuropsychological dysfunction in depressed suicide attempters. American Journal of Psychiatry. 2001;158(5):735-741.
https://doi.org/10.1176/appi.ajp.158.5.735
Desmyter S, Van Heeringen C, Audenaert K. Structural and functional neuroimaging studies of the suicidal brain. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2011;35(4):796-808.
https://doi.org/10.1016/j.pnpbp.2010.12.026
Townsend J, Altshuler LL. Emotion processing and regulation in bipolar disorder: a review. Bipolar Disorders. 2012;14(4):326-339.
https://doi.org/10.1111/j.1399-5618.2012.01021.x
Baker JT, Holmes AJ, Masters GA, et al. Disruption of cortical association networks in schizophrenia and psychotic bipolar disorder. JAMA Psychiatry. 2013;
https://doi.org/10.1001/jamapsychiatry.2013.3469
Keller J, Gomez R, Williams G, et al. HPA axis in major depression: cortisol, clinical symptomatology and genetic variation predict cognition. Molecular Psychiatry. 2017/04/01 2017;22(4):527-536.
https://doi.org/10.1038/mp.2016.120
Oquendo MA, Galfalvy H, Russo S, et al. Prospective study of clinical predictors of suicidal acts after a major depressive episode in patients with major depressive disorder or bipolar disorder. American Journal of Psychiatry. 2004;161(8):1433-1441.
https://doi.org/10.1176/appi.ajp.161.8.1433
McGorry PD. Issues for DSM-V: clinical staging: a heuristic pathway to valid nosology and safer, more effective treatment in psychiatry. Am J Psychiatry. Jun 2007;164(6):859-60.
https://doi.org/10.1176/ajp.2007.164.6.859
Leboyer M, Schurhoff F. Searching Across Diagnostic Boundaries. Schizophrenia Bulletin. 2014;40(5):946-948.
https://doi.org/10.1093/schbul/sbu112
Østergaard SD, Bille J, Søltoft-Jensen H, Lauge N, Bech P. The validity of the severity-psychosis hypothesis in depression. Journal of affective disorders. 2012;140(1):48-56.
https://doi.org/10.1016/j.jad.2012.01.039
Forty L, Jones L, Jones I, et al. Is depression severity the sole cause of psychotic symptoms during an episode of unipolar major depression? A study both between and within subjects. J Affect Disord. Apr 2009;114(1-3):103-9.
https://doi.org/10.1016/j.jad.2008.06.012
Ohayon MM, Schatzberg AF. Prevalence of depressive episodes with psychotic features in the general population. American Journal of Psychiatry. 2002;159(11):1855-1861.
https://doi.org/10.1176/appi.ajp.159.11.1855
Maj M, Pirozzi R, Magliano L, Fiorillo A, Bartoli L. Phenomenology and prognostic significance of delusions in major depressive disorder: a 10-year prospective follow-up study. The Journal of clinical psychiatry. 2007;68(9):1411.
https://doi.org/10.4088/JCP.v68n0913
Baumeister RF. Suicide as escape from self. Psychological review. 1990;97(1):90.
https://doi.org/10.1037/0033-295X.97.1.90
Li S, Yaseen ZS, Kim H-J, et al. Entrapment as a mediator of suicide crises. BMC Psychiatry. 2018/01/08 2018;18(1):4.
https://doi.org/10.1186/s12888-018-1587-0
Bostwick JM, Pabbati C, Geske JR, McKean AJ. Suicide attempt as a risk factor for completed suicide: even more lethal than we knew. American journal of psychiatry. 2016;173(11):1094-1100.
https://doi.org/10.1176/appi.ajp.2016.15070854
Lester D. The role of shame in suicide. Suicide and Life-Threatening Behavior. 1997;27(4):352-361.
Wurmser L. Trauma, shame conflicts, and affect regression: Discussion of "wounded but still walking". Psychoanalytic Inquiry. 1999/01/01 1999;19(3):309-319.
https://doi.org/10.1080/07351699909534252
Herman JL. Trauma and recovery. Basic Books; 1997.
Nelson WH, Khan A, Orr WW. Delusional depression: Phenomenology, neuroendocrine function, and tricyclic antidepressant response. Journal of affective disorders. 1984;6(3):297-306.
https://doi.org/10.1016/S0165-0327(84)80008-7
Miller F, Chabrier LA. The relation of delusional content in psychotic depression to life-threatening behavior. Suicide Life Threat Behav. Spring 1987;17(1):13-7.
https://doi.org/10.1111/j.1943-278X.1987.tb00058.x
Hori M, Shiraishi H, Koizumi J. Delusional depression and suicide. Psychiatry and clinical neurosciences. 1993;47(4):811-817.
https://doi.org/10.1111/j.1440-1819.1993.tb01828.x
Deisenhammer EA, Ing CM, Strauss R, Kemmler G, Hinterhuber H, Weiss EM. The duration of the suicidal process: how much time is left for intervention between consideration and accomplishment of a suicide attempt? J Clin Psychiatry. Jan 2009;70(1):19-24.
https://doi.org/10.4088/JCP.07m03904
Kvale S. Interviews: An Introduction to Qualitative Research Interviewing, Sage. Thousand Oaks, CA. 1996;
Miles MB, Huberman AM. Qualitative data analysis: An expanded sourcebook. Sage; 1994.
Leadholm AK, Rothschild AJ, Nolen WA, Bech P, Munk-Jorgensen P, Ostergaard SD. The treatment of psychotic depression: is there consensus among guidelines and psychiatrists? J Affect Disord. Feb 20 2013;145(2):214-20.
https://doi.org/10.1016/j.jad.2012.07.036
Nome S, Holsten F. A prospective longitudinal study of utilization of a psychiatric hospital in Hordaland County, Norway, from 1985 to 2003. Nordic journal of psychiatry. Apr 2011;65(2):117-24.
https://doi.org/10.3109/08039488.2010.504991
Bock C, Bukh JD, Vinberg M, Gether U, Kessing LV. Validity of the diagnosis of a single depressive episode in a case register. Clinical Practice and Epidemiology in Mental Health. 2009;5(1):4.
https://doi.org/10.1186/1745-0179-5-4
Kessing L. Validity of diagnoses and other clinical register data in patients with affective disorder. European psychiatry. 1998;13(8):392-398.
https://doi.org/10.1016/S0924-9338(99)80685-3
Hjelmeland H, Knizek BL. Why we need qualitative research in suicidology. Suicide Life Threat Behav. Feb 2010;40(1):74-80.
https://doi.org/10.1521/suli.2010.40.1.74
van Os J, Reininghaus U. Psychosis as a transdiagnostic and extended phenotype in the general population. World Psychiatry. Jun 2016;15(2):118-24.
https://doi.org/10.1002/wps.20310
Tamminga CA, Ivleva EI, Keshavan MS, et al. Clinical phenotypes of psychosis in the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP). Am J Psychiatry. Nov 2013;170(11):1263-74.
https://doi.org/10.1176/appi.ajp.2013.12101339
Hacker PMS. The intellectual powers: A study of human nature. John Wiley & Sons; 2013.
https://doi.org/10.1002/9781118609033
Ness E, Skotte JR, Christensen TB, Andresen JFJTfDnl. Can we save more lives? 2020;
Oeye C, Bjelland AK, Skorpen A. Doing participant observation in a psychiatric hospital--Research ethics resumed. Social Science & Medicine. 2007;65(11):2296-2306.
https://doi.org/10.1016/j.socscimed.2007.07.016
Cukrowicz K, Smith P, Poindexter E. The effect of participating in suicide research: does participating in a research protocol on suicide and psychiatric symptoms increase suicide ideation and attempts? Suicide Life Threat Behav. Dec 2010;40(6):535-43.
https://doi.org/10.1521/suli.2010.40.6.535
Deeley ST, Love AW. Does asking adolescents about suicidal ideation induce negative mood state? Violence and victims. 2010;25(5):677-88.
https://doi.org/10.1891/0886-6708.25.5.677
Mathias CW, Michael Furr R, Sheftall AH, Hill-Kapturczak N, Crum P, Dougherty DM. What's the harm in asking about suicidal ideation? Suicide and Life- Threatening Behavior. Jun 2012;42(3):341-51.
