ArticleBipolar disorders2018
Mixed state and suicide: Is the effect of mixed state on suicidal behavior more than the sum of its parts?
Article in Bipolar disorders, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
21 citing papers in PubMed, 56 citations in OpenAlex.
- The role of predominant polarity in older age bipolar disorder.International journal of bipolar disorders · 2025Article
- Episode-specific cortical functional connectome reorganization and neurobiological correlates in bipolar disorder: a cross-sectional study.BMC medicine · 2025Article
- Staging of suicidality in bipolar disorder: Findings from the FACE-BD cohort (FondaMental Advanced Centers of Expertise for Bipolar Disorders).European psychiatry : the journal of the Association of European Psychiatrists · 2025Article
- The influence of depressive and manic symptoms on suicidal ideation in mixed mood states.International journal of bipolar disorders · 2025Article
- Depressive mixed state and anxious distress as risk factors for suicidal behavior during major depressive episodes.Scientific reports · 2025Article
- A national survey of suicidality and non-suicidal self-injury in bipolar disorder: insights from network analysis.BMC psychiatry · 2025Article
- Associations between NIH Toolbox Emotion Battery measures and previous suicide attempt in bipolar I disorder.Journal of affective disorders · 2025Article
- Validation of a youth suicide risk calculator in an adult sample with bipolar disorder.Journal of affective disorders · 2024Article
- Do bipolar disorder symptom profiles matter for suicide risk? A latent class approach to investigating differences in suicidal desire and acquired capability.Suicide & life-threatening behavior · 2024Article
- Hippocampal subfield morphology from first episodes of bipolar disorder type II and major depressive disorder in a drug naïve Chinese cohort.Frontiers in psychiatry · 2024Article
- The Mixed Tendency in Bipolar Disorder: An Operational Proposal for the Integration of Mixed Episodes in Predominant Polarity.Journal of clinical medicine · 2023Article
- Fell on Black Days: Analyzing the Song Lyrics of Chris Cornell for Insight into Depression and Suicide.International journal of environmental research and public health · 2023Article
- Detailed assessment of suicidal ideation in youth with bipolar disorder versus major depressive disorder.Bipolar disorders · 2023Article
- Efficacy of Quetiapine Monotherapy and Combination Therapy for Patients with Bipolar Depression with Mixed Features: A Randomized Controlled Pilot Study.Pharmaceuticals (Basel, Switzerland) · 2023Article
- Symptoms of mania and anxiety do not contribute to suicidal ideation or behavior in the presence of bipolar depression.Psychiatry research · 2022Article
- Suicide Risk and Mood Disorders in Women in the Postpartum Period: a Longitudinal Study.The Psychiatric quarterly · 2021Article
- Moderators of the association between depressive, manic, and mixed mood symptoms and suicidal ideation and behavior: An analysis of the National Network of Depression Centers Mood Outcomes Program.Journal of affective disorders · 2021Article
- Candidate Biomarkers of Suicide Crisis Syndrome: What to Test Next? A Concept Paper.The international journal of neuropsychopharmacology · 2020Review
- Suicide Risk in Bipolar Disorder: A Brief Review.Medicina (Kaunas, Lithuania) · 2019Review
- Affective Temperaments and Clinical Course of Bipolar Disorder: An Exploratory Study of Differences among Patients with and without a History of Violent Suicide Attempts.Medicina (Kaunas, Lithuania) · 2019Article
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 1 country.
Funding
Abstract
objectiveTo assess whether suicidal behavior during mixed states exceeds that expected from the manic or depressive components alone.
methodsThis study included 429 participants with bipolar disorder from the National Institute of Mental Health Collaborative Depression Study (CDS). Mood and suicidal behavior were captured using the Longitudinal Interval Follow-up Evaluation and the Schedule of Affective Disorders and Schizophrenia. Suicidal behavior during each mood state, relative to euthymia, was analyzed using Cox regression to allow for repeated events, with a frailty term to account for intra-participant correlation. Mixed states were modeled as a depression-by-mania interaction.
resultsIndividuals with a history of mixed states were at higher risk of suicidal behavior and spent more time depressed, compared to subjects with no such history. In bipolar I disorder, risk increased during episodes of mania (hazard ratio [HR]: 1.96, 95% confidence interval [CI]: 1.28-2.99, P = .0019) and depression (HR: 5.49, 95% CI: 4.01-7.51, P < .0001) and there was a less than additive effect of mixed states. In bipolar II disorder, risk was increased during episodes of depression (HR: 3.66, 95% CI: 2.51-5.35, P < .0001) and there was no excess risk during mixed states beyond that attributable to the depressed component. Most of the excess risk (71%) among those with a history of mixed states was attributable to a depression predominant course of illness.
conclusionsIndividuals with mixed states are at high risk of suicidal behavior, largely due to more time spent depressed. Clinicians should aggressively treat depression to mitigate suicide risk for patients with or without mixed states.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.