Abstract
Background: This study explores among individuals with a major depressive episode (MDE) the potential impact of mixed features on the risk of suicide attempt, suicidal thoughts, self-harm intentions, and thoughts of death.Methods: Data from the French Mental Health in General Population (MHGP) survey (1999-2003) were analyzed, including 128 participants meeting DSM 5 criteria for MDE with mixed features (MDE with at least 3 manic symptoms) and 3,312 participants experiencing MDE without mixed features. Our primary analysis focused on suicide attempt, with additional examination of recent suicidal thoughts, self-harm intentions, and thoughts of death. Multivariable regression models were performed to adjust for potential confounding variables, including sociodemographics, previous suicide attempt, number of depressive symptoms, and psychiatric comorbidity.Results: MDE with mixed features was significantly associated with an increased risk of suicide attempt (adjusted odds ratio [AOR] = 1.69; 95% CI, 1.26-2.25). This association did not significantly differ between men and women. Furthermore, the number of manic symptoms demonstrated a dose-dependent relationship with an increased risk of suicide attempt (AOR = 1.18; 95% CI, 1.07-1.30; P < .001). Mixed features were also associated with suicide attempt among individuals with MDE and without recent suicidal thoughts (AOR = 2.74; 95% CI, 1.36-5.54).Conclusion: This study underscores the importance of assessing mixed features when evaluating the risk of suicide attempt in individuals with MDE. Mechanisms underlying this association might be independent of progression from thoughts of death to suicidal thoughts, suicidal intention, and ultimately, suicide attempt.