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Relating irritability and suicidal ideation using mood and anxiety
  1. Gin Malhi1,2,
  2. Erica Bell1,2,
  3. Pritha Das1,2,
  4. Tim Outhred1,2
  1. 1 Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
  2. 2 Department of Psychological Medicine, The University of Sydney Northern Clinical School, St Leonards, New South Wales, Australia
  1. Correspondence to Professor Gin Malhi, University of Sydney Sydney Medical School, Sydney, NSW 2065, Australia; gin.malhi{at}


Background Suicide is common in the context of depression and bipolar disorders, but there remains a lack of understanding as to how suicide ideation, a common symptom of mood disorders, progresses to suicidal behaviour. Irritability, a feature of some types of depression, is thought to contribute to the development of suicidal behaviour, but these associations are not well established.

Objective To examine the relationship between irritability and suicide ideation according to the subtype of depression expressed in patients with mood disorder.

Methods 75 patients with mood disorders seen at the CADE (Clinical Assessment Diagnostic Evaluation) Clinic underwent clinical assessment for suicidal ideation (Paykel Suicide Scale), symptom severity (Young Mania Rating Scale (YMRS), Hamilton Rating Scale for Depression (HAM-D) (anxious depression), Montgomery-Åsberg Depression Rating Scale (MADRS) (melancholic depression)) and irritability (item 5 of the YMRS).

Findings Interestingly, irritability correlated with mania (r=0.734, p<0.001 (YMRS)) and depressive symptom scores (r=0.369, p<0.001 (MADRS); r=0.477, p<0.001 (HAM-D)), which in turn correlated with suicide ideation scores (r=0.364, p<0.01 (MADRS); r=0.275, p=0.017 (HAM-D)). However, despite this indirect association, there was no direct correlation between irritability and suicide ideation (r=0.050, p>0.05).

Conclusions The nature of the relationship between irritability and suicidal ideation is determined by the emotional context within which irritability operates.

Clinical implications Findings suggest that rather than examining irritability alone, consideration of the subtype of depression, especially that of anxious depression, should be paramount in assessing suicide risk.

  • irritability
  • suicide
  • depression
  • anxiety
  • melancholia
  • major depressive disorder
  • bipolar disorder
  • bipolar depression

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  • Contributors GM, PD and TO developed, planned and conducted the study. EB conducted the analysis of the data. GM, EB, PD and TO contributed to the writing of the finalised article.

  • Funding This research is supported by grants PRG-0-090-14 and SRG- 0-089-16 awarded to GM, PD and TO by the American Foundation for Suicide Prevention, as well as the Australian Rotary Health, the Sydney Medical School Foundation, SPARK Sydney, the Ramsay Health Research and Teaching Fund, and an NHMRC Program Grant (APP1073041).

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Foundation for Suicide Prevention.

  • Competing interests GM has received grant or research support from NHMRC, NSW Health, The University of Sydney, American Foundation for Suicide Prevention, Australian Rotary Health, AstraZeneca, Eli Lilly & Co, Organon, Pfizer, Servier and Wyeth; has been a speaker for AstraZeneca, Eli Lilly & Co, Janssen Cilag, Lundbeck, Pfizer, Ranbaxy, Servier and Wyeth; and has been a consultant for AstraZeneca, Eli Lilly & Co, Janssen Cilag, Lundbeck and Servier. EB, PD and TO have no conflicts of interest to report.

  • Ethics approval The University of Sydney and Royal North Shore Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.