The Association of Baseline Suicidality With Treatment Outcome in Psychotic Depression
Department of Psychiatry
Mental and Social Health | Psychiatry | Psychiatry and Psychology
OBJECTIVE: To examine the association between baseline suicidality and outcome of major depression in a randomized controlled trial of the pharmacotherapy of psychotic depression and to explore the interaction of suicidality, randomized treatment assignment, and depression outcome.
METHODS: This study was a secondary analysis of data from 258 persons aged 18 years or older with DSM-IV-defined major depressive disorder with psychotic features who participated in a 12-week randomized controlled trial (RCT) comparing olanzapine plus sertraline with olanzapine plus placebo (the Study of the Pharmacotherapy of Psychotic Depression [STOP-PD], which ran from 2002 to 2007). The independent variable was baseline suicidality, defined by 4 groups (suicide attempt in the current episode, active suicidal ideation, passive suicidal ideation, and no suicidality). The outcome variables were change in 16-item Hamilton Depression Rating Scale (HDRS(1)(6)) total score (excluding the suicide item) over time and remission of psychotic depression over time.
RESULTS: Suicidality groups did not significantly differ on baseline HDRS(1)(6) total score. Baseline suicidality group was significantly associated with change in HDRS(1)(6) score over time in the sample as a whole (F(3),(1)(3)(9)(4) = 8.17; P < .0001), but was not significantly associated with probability of remission over time. Among participants assigned to olanzapine and placebo, persons with no suicidality had a significantly greater reduction in HDRS(1)(6) total score compared to those with passive suicidal ideation (7.5-point difference in change scores between the 2 groups; 95% CI, 4.3-10.7 t(1)(3)(9)(4) = 4.61, P < .0001), active suicidal ideation (4.4 points; 95% CI, 1.4-7.4; t(1)(3)(9)(4) = 2.85, P = .0176), or suicide attempts (6.1 points; 95% CI, 2.8-9.4; t(1)(3)(9)(4) = 3.66, P = .0015). The 12-week change from baseline in HDRS(1)(6) score for patients with no suicidality was not significantly different between the 2 treatment arms. However, the 12-week HDRS(1)(6) improvement was significantly greater in the olanzapine plus sertraline arm, compared with the olanzapine plus placebo arm, for patients with suicide attempts (8.7-point difference in change scores between the 2 groups; 95% CI, 5.1-12.4; t(1)(3)(9)(4) = 4.75, P < .0001), active suicidal ideation (8.1 points; 95% CI, 4.5-11.7; t(1)(3)(9)(4) = 4.38, P < .0001), or passive suicidal ideation (5.7 points; 95% CI, 2.2-9.2; t(1)(3)(9)(4) = 3.23, P = .0012), respectively.
CONCLUSIONS: Baseline suicidality predicted worse acute treatment outcome of psychotic depression. However, participants with suicidality had a better outcome when treated with the combination of olanzapine and sertraline than when treated with olanzapine plus placebo.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00056472.
DOI of Published Version
J Clin Psychiatry. 2017 Apr 25. doi: 10.4088/JCP.16m10881. Link to article on publisher's site
The Journal of clinical psychiatry
Bingham KS, Rothschild AJ, Mulsant BH, Whyte EM, Meyers BS, Weill Cornell Medical College, Szanto K, Flint AJ. (2017). The Association of Baseline Suicidality With Treatment Outcome in Psychotic Depression. University of Massachusetts Medical School Faculty Publications. https://doi.org/10.4088/JCP.16m10881. Retrieved from https://escholarship.umassmed.edu/faculty_pubs/1314