Association of clinical characteristics, depression remission and suicide risk with discrepancies between self- and...

Area of Science:

• Psychiatry
• Clinical Psychology
• Epidemiology

Background:

• Suicidal ideation (SI) assessment in clinical practice often shows discrepancies between patient self-reports and clinician ratings.
• Understanding these discrepancies is crucial for accurate risk assessment and effective treatment of depression.

Purpose of the Study:

• To investigate the association between discrepant SI ratings and clinical characteristics, depression remission, and suicide attempt (SA) risk.
• To determine which SI assessment method (self-report or clinician rating) better predicts depression remission and SA risk.

Main Methods:

• Analysis of two large, prospective, naturalistic cohorts (LUEUR and GENESE) of French adult outpatients with unipolar depression.
• SI presence assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS) suicidal item (score ≥3).
• Discordant SI defined as detection by only one evaluator (patient or clinician).

Main Results:

• Discordant SI was observed in 34% (LUEUR) and 49.3% (GENESE) of patients.
• Patients with current SI (concordant and discordant) exhibited more severe clinical characteristics and higher SA risk compared to those without SI.
• The concordant SI group presented the highest SA risk during follow-up.
• Both self- and clinician-rated SI showed comparable predictive power for SA risk and depression non-remission.

Conclusions:

• Discrepancies in SI assessment are frequent in adult depression cohorts.
• Current SI, whether concordant or discordant, is linked to more severe clinical presentations.
• Concordant SI ratings identify patients at the highest risk for suicide attempts.
• Improving the methods for assessing suicidal ideation is critical for patient safety and effective depression management.