Association of anger attacks with suicidal ideation in adults with major depressive disorder: Findings from the EMBARC study

Manish Kumar Jha, Maurizio Fava, Abu Minhajuddin, Cherise Chin Fatt, David Mischoulon, Christina Cusin, Madhukar H. Trivedi

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: This report evaluates whether anger attacks (sudden uncharacteristic bouts of anger that are associated with autonomic arousal and/or aggression) in patients with major depressive disorder (MDD) are associated with elevated suicidal ideation (SI; active suicidal thoughts and plans). Methods: Participants of Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) study who completed Massachusetts General Hospital Anger Attack Questionnaire (AAQ) at baseline were included (n = 293). Levels of SI (suicidal thoughts factor of Concise Health Risk Tracking) were compared at baseline with generalized linear models, and during Stage 1 (baseline-to-week-8) and Stage 2 (week-8-to-week-16) with repeated-measures mixed model analyses. Covariates included age, sex, race, ethnicity, site, and treatment arm. Results: At baseline, participants with (n = 109) versus without anger attacks (n = 184) had higher levels of SI (Cohen's d effect size [d] = 1.20). Those with ≥9 anger attacks in the past month had significantly higher SI than those with 1–2 (d = 1.21), 3–4 (d = 1.48), and 5–8 (d = 0.94) anger attacks in the past month. Furthermore, participants with anger attacks at baseline reported higher SI at each post-baseline visit (both Stages 1 and 2) of EMBARC study (d = 0.39–0.77; all p <.05). Associations between anger attacks and SI were significant even after controlling for irritability, hostility, anxious arousal, depression, suicide propensity, and self-reported pain at baseline and lifetime suicidal tendencies. Similar results were found in participants with aggressive behaviors. Conclusion: Anger attacks in outpatients with MDD may be associated with chronically elevated SI. Clinical Trials Registration: Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care for Depression (EMBARC); NCT01407094; https://clinicaltrials.gov/ct2/show/NCT01407094.

Original languageEnglish (US)
Pages (from-to)57-66
Number of pages10
JournalDepression and anxiety
Volume38
Issue number1
DOIs
StatePublished - Jan 2021

Keywords

  • anger attack
  • antidepressant treatment
  • irritability
  • major depressive disorder
  • suicidality

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

Fingerprint

Dive into the research topics of 'Association of anger attacks with suicidal ideation in adults with major depressive disorder: Findings from the EMBARC study'. Together they form a unique fingerprint.

Cite this