{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T11:18:10Z","timestamp":1776511090121,"version":"3.51.2"},"reference-count":41,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,12,9]],"date-time":"2019-12-09T00:00:00Z","timestamp":1575849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["ZIAMH002927"],"award-info":[{"award-number":["ZIAMH002927"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The suicide crisis is a relatively short\u2010lived psychiatric emergency, with transient symptoms that ebb and flow around the suicide attempt. Understanding the dynamic processes of symptoms before and after suicide attempt may aid future prevention efforts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were drawn from the NIMH STEP\u2010BD study, which followed 4,360 patients with bipolar disorder; a subset attempted suicide during the trial (245\/4100 or 5.97% of the sample eligible for analysis). This analysis focused on change in suicidal ideation (SI) in the 120\u00a0days before and 120\u00a0days after suicide attempt; similar analyses were conducted for other depressive symptoms. Generalized linear mixed models with a two\u2010piece linear function of time corresponding to pre\u2010 and post\u2010suicide attempt trends were used.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>SI ratings from 216 individuals were analyzed (n\u00a0=\u00a01,231 total; n\u00a0=\u00a0395 pre\u2010attempt, n\u00a0=\u00a0126 circa\u2010attempt, n\u00a0=\u00a0710 post\u2010attempt) and compared to data from a matched sample of 648 non\u2010attempters. SI worsened in the 120\u00a0days pre\u2010attempt but improved afterwards, reaching non\u2010attempter levels by 90\u00a0days post\u2010attempt. A similar pattern was found for other depressive symptoms, including depressed mood, loss of interest, guilt, and self\u2010esteem. Pre\/post differences in tension\/activating symptoms of depression\u2014anxiety, agitation, and irritability\u2014were less pronounced and more time\u2010limited.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The suicide crisis is dynamic, and the days before and after suicide attempt may be particularly critical. The findings extend previous research on proximal symptoms of suicide and underscore that some SI and affective\/cognitive symptoms of depression can remain elevated up to 90\u00a0days post\u2010attempt in individuals with bipolar disorder.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.12873","type":"journal-article","created":{"date-parts":[[2019,11,18]],"date-time":"2019-11-18T10:34:27Z","timestamp":1574073267000},"page":"245-254","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Symptom trajectories in the months before and after a suicide attempt in individuals with bipolar disorder: A STEP\u2010BD study"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5304-0127","authenticated-orcid":false,"given":"Elizabeth D.","family":"Ballard","sequence":"first","affiliation":[{"name":"Experimental Therapeutics &amp; Pathophysiology Branch Intramural Research Program National Institute of 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