Factors associated with transitioning from suicidal ideation to suicide attempt in the short-term: Two large cohorts of depressed outpatients

Background: This study explores factors associated with transitioning from recent suicidal ideation (SI) to suicide attempt (SA) in depressed outpatients.Methods: This is a case-control study nested in two cohorts (LUEUR and GENESE) of depressed adult outpatients recruited in France and followed up for six weeks. SI, depression, anxiety, insomnia, impulsivity, and hope-lessness were assessed with validated scales. Differences between patients with SI who attempted suicide during follow up and those who did not were explored using logistic regressions.Results: There was a slight majority of females in both cohorts. Mean age was 47.2 years in LUEUR and 49.4 years in GENESE. Of the 3785 participants in the LUEUR cohort, 72 (2.1 %) attempted suicide within the 6-week period vs. 19 of the 2698 participants (0.7 %) in the GENESE cohort. In LUEUR, factors associated with SA within the 6-week period were lifetime history of SA (OR = 5.35, 95 % CI = 3.30-8.66), high SI at baseline (OR = 3.87, 95 % CI = 2.4-6.24), associated treatments (OR = 3.28, 95 % CI = 2.00-5.38), and less improvement over follow-up in the following symptoms: SI (OR = 3.64, 95 % CI = 1.89-7.02), depression (OR = 3.66, 95 % CI = 1.76-7.62), and anxiety (OR = 3.26, 95 % CI = 1.46-7.27). In GENESE, associated factors were lifetime history of SAs (OR = 9.93, 95 % CI = 3.83-25.80), and less improvement in SI (OR = 9.20, 95 % CI = 3.61-23.44). Limitations: Heterogeneity of cohorts prevented from performing a pooled analysis with a greater sample size.Conclusions: In depressed outpatients, lack of improvement was strongly associated with a short-term SA, particularly in patients with a history of previous SAs. Fast acting treatment on SI and depression may help prevent SAs.