Citation

Baryshnikov I, Rosenström T, Isometsä E. J. Affect. Disord. 2024; ePub(ePub): ePub.

Copyright

(Copyright © 2024, Elsevier Publishing)

DOI

10.1016/j.jad.2023.12.091

PMID

38232774

Abstract

INTRODUCTION: Patients with depression often require inpatient treatment due to their high suicide risk. Ecological momentary assessment (EMA) studies have shown that suicidal ideation (SI) fluctuates over time. As affective instability and psychological pain (PP) are common experiences in borderline personality disorder (BPD), often comorbid with depression, we examined factors predicting short-term changes of SI in depressive inpatients with or without BPD.

METHODS: Psychiatric inpatients with depression with (N = 30) or without (N = 37) comorbid BPD assessed their anxiety, PP, severity of depression, SI, and hopelessness three times daily using visual analogue scales. Multilevel regression models were estimated.

RESULTS: Altogether 4320 EMA observations, spanning on average 3.4 successive days, were collected. Only severity of depression (β = 0.19; [95 % CI = 0.06, 0.32]) and previous SI (β = 0.32; [95 % CI = 0.23, 0.41]) predicted near-future SI within several hours. PP predicted near-future SI in inpatients with depression and BPD (β = 0.28; [95 % CI = 0.11, 0.46]), but not in patients without BPD. LIMITATIONS: The follow-up data represents only the first days of hospitalization. The context of the EMA is the acute psychiatric ward, affecting generalizability to outpatients.

CONCLUSIONS: Short-terms changes in SI are predicted by changes in severity of depression and previous SI in depressed inpatients without BPD, and also by changes in PP in depressed inpatients with BPD. As SI and its risk factors may oscillate within a time scale of hours, frequent monitoring of momentary severity of depression, PP, and SI may be warranted in inpatient settings.

Language: en

Keywords

Depression; Suicidal ideation; Borderline personality disorder; Ecological momentary assessment; Inpatient psychiatric treatment