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SEA RCHPU BMED FOR

M A Oquendo

M M Perez-Rod riguez

E P oh

G Sullivan

A K Burke

M E Sublette

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Original Article

Molecular Psychiatry 19 , 902-909 (August 2014) |doi:10.1038/mp.2013.128

Life events: a complex role inthe timing of suicidal behavioramong depressed patients

M A Oquendo, M M Perez-Rodriguez, E Poh, GSullivan, A K Burke, M E Sublette, J J Mann andH Galfalvy

Suicidal behavior is often conceptualize das a response to overwhelming stress. O urmodel posits that given a propensity foracting on suicidal urges, stressors such aslife events or major depressive episode s(MDEs) determine the timing of suicida lacts. Depressed patients (n 415) wereassessed prospectively for suicide attemptsand suicide, life events and MDE over 2

years. Longitudinal data were divided i nto1-month intervals characterized by MD E(yes no), suicidal behavior (yes no) and lifeevent scores. Marginal logistic regressi onmodels were fit, with suicidal behavior asthe response variable and MDE and lifeevent score in either the same or previousmonth, respectively, as time-varying

covariates. Among 7843 personmonths,33 had MDE and 73 had life events.MDE increased the risk for suicidal

behavior (odds ratio (OR) 4.83, P0.0001). Life event scores were unrelatedto the timing of suicidal behavior (OR 1.06per 100 point increase, P 0.32), evenduring a MDE (OR 1.12, P 0.15). However,among those without borderlinepersonality disorder (BPD), both health-and work-related life events were key precipitants, as was recurrent MDE, with a

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Committee on PublicationEthics . Molecular Psychiatry ISSN 1359-4184 EISSN 1476-5578

13-fold effect. The relationship of lifeevents to suicidal behavior among those

with BPD was more complex. RecurrentMDE was a robust precipitant for suicidal

behavior, regardless of BPD comorbidity.The specific nature of life events is key tounderstanding the timing of suicidal

behavior. Given unanticipated resultsregarding the role of BPD and study limitations, these findings requirereplication. Of note, that MDE, a treatablerisk factor, strongly predicts suicidal

behaviors is cause for hope.

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