Identifying suicide attempt risk in mood disorders: A multivariate analysis from a specialized clinic

Suicide attempts are a major concern in mood disorders. Identifying clinical and treatment-related risk factors beyond diagnostic category may improve prevention in high-risk, tertiary-care populations. We conducted a retrospective chart review of adults assessed at a tertiary care mood disorders clinic between March and June 2024. Diagnoses were established using DSM-5-TR and classified as Major Depressive Disorder (MDD; n = 386) or Bipolar Disorder (BD; n = 189). Analyses were restricted to patients with available and reliable documentation of suicide attempt history. Sociodemographic, clinical, and pharmacological variables were compared between patients with and without a suicide attempt history, and variables significant in univariate analyses were entered into a multivariate logistic regression model. Among 333 patients with available information, 131 (39.3 %) had a documented lifetime suicide attempt, corresponding to 22.8 % of the total cohort. Attempters were more often female (76 % vs. 63 %, p = 0.012), had a personality disorder (37 % vs. 18 %, p < 0.001), were more frequently treated with lithium (15 % vs. 7 %, p = 0.005), and had a greater medication burden (4.7 vs. 4.3, p = 0.028). They more frequently experienced hospitalization (82 % vs. 36 %, p < 0.001) and interventional treatments (52 % vs. 34 %, p < 0.001), especially electroconvulsive therapy ( p = 0.001). BD patients showed higher unadjusted attempt rates (51.1 % vs. 34.9 %, OR = 1.95, 95 % CI [1.34–2.84], p = 0.001), but diagnostic category did not remain significant after multivariable adjustment. Independent predictors were psychiatric hospitalization (OR = 7.13, 95 % CI [3.99–12.72], p < 0.001), lithium treatment (OR = 3.25, 95 % CI [1.22–8.65], p = 0.018), comorbid personality disorder (OR = 2.44, 95 % CI [1.33–4.48], p = 0.004), and female gender (OR = 1.95, 95 % CI [1.08–3.52], p = 0.027). In this tertiary care cohort, suicide attempts were more strongly associated with markers of illness severity, psychiatric comorbidity, and treatment intensity than with mood disorder subtype. Suicide risk assessment in specialized settings should prioritize these clinical markers to better inform prevention strategies. • Suicide attempts were more frequent in bipolar disorder than major depressive disorder in unadjusted analyses. • Suicide attempts were independently associated with psychiatric hospitalization, lithium use, comorbid personality disorder, and female gender. • Psychiatric hospitalization showed the strongest association, with nearly seven-fold higher odds of suicide attempts. • Lithium use was associated with suicide attempts and likely reflected greater illness severity. • Suicide attempts in mood disorders were more strongly associated with illness severity and comorbidity than with diagnostic subtype.