{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T01:08:05Z","timestamp":1773104885183,"version":"3.50.1"},"reference-count":18,"publisher":"BMJ","issue":"3","funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001455","name":"American Foundation for Suicide Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001455","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Evid Based Mental Health"],"accepted":{"date-parts":[[2019,6,17]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the relationship between irritability and suicide ideation according to the subtype of depression expressed in patients with mood disorder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>75 patients with mood disorders seen at the CADE (Clinical Assessment Diagnostic Evaluation) Clinic underwent clinical assessment for<jats:italic>suicidal ideation<\/jats:italic>(Paykel Suicide Scale),<jats:italic>symptom severity<\/jats:italic>(Young Mania Rating Scale (YMRS), Hamilton Rating Scale for Depression (HAM-D) (anxious depression), Montgomery-\u00c5sberg Depression Rating Scale (MADRS) (melancholic depression)) and<jats:italic>irritability<\/jats:italic>(item 5 of the YMRS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Interestingly, irritability correlated with mania (r=0.734, p&lt;0.001 (YMRS)) and depressive symptom scores (r=0.369, p&lt;0.001 (MADRS); r=0.477, p&lt;0.001 (HAM-D)), which in turn correlated with suicide ideation scores (r=0.364, p&lt;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&gt;0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The nature of the relationship between irritability and suicidal ideation is determined by the emotional context within which irritability operates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical implications<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1136\/ebmental-2019-300100","type":"journal-article","created":{"date-parts":[[2019,6,27]],"date-time":"2019-06-27T21:15:45Z","timestamp":1561670145000},"page":"95-99","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Relating irritability and suicidal ideation using mood and anxiety"],"prefix":"10.1136","volume":"22","author":[{"given":"Gin","family":"Malhi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8483-8497","authenticated-orcid":false,"given":"Erica","family":"Bell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pritha","family":"Das","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Outhred","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,6,27]]},"reference":[{"key":"2024052110574889000_22.3.95.1","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1177\/0004867418804066","article-title":"Australia\u2019s \u2019Better Access' scheme: Has it had an impact on population mental health?","volume":"52","author":"Jorm","year":"2018","journal-title":"Aust N Z J Psychiatry"},{"key":"2024052110574889000_22.3.95.2","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12087"},{"key":"2024052110574889000_22.3.95.3","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1111\/bdi.12622","article-title":"Modeling suicide in bipolar disorders","volume":"20","author":"Malhi","year":"2018","journal-title":"Bipolar Disord"},{"key":"2024052110574889000_22.3.95.4","doi-asserted-by":"publisher","DOI":"10.1002\/da.21939"},{"key":"2024052110574889000_22.3.95.5","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291704002612"},{"key":"2024052110574889000_22.3.95.6","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.jad.2018.09.024","article-title":"Identifying and differentiating melancholic depression in a non-clinical sample","volume":"243","author":"Parker","year":"2019","journal-title":"J Affect Disord"},{"key":"2024052110574889000_22.3.95.7","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.jad.2015.05.028","article-title":"Anhedonia in melancholic and non-melancholic depressive disorders","volume":"184","author":"Fletcher","year":"2015","journal-title":"J Affect Disord"},{"key":"2024052110574889000_22.3.95.8","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-5618.4.s1.3.x"},{"key":"2024052110574889000_22.3.95.9","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1007\/s00787-018-1234-9","article-title":"Suicidal behaviors and irritability in children and adolescents: a systematic review of the nature and mechanisms of the association","volume":"28","author":"Benarous","year":"2019","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"2024052110574889000_22.3.95.10","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.jad.2018.07.010","article-title":"Association between irritability and suicide-related outcomes across the life-course. Systematic review of both community and clinical studies","volume":"239","author":"Orri","year":"2018","journal-title":"J Affect Disord"},{"key":"2024052110574889000_22.3.95.11","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.23.1.56"},{"key":"2024052110574889000_22.3.95.12","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.134.4.382"},{"key":"2024052110574889000_22.3.95.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2009.02.001"},{"key":"2024052110574889000_22.3.95.14","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.133.5.429"},{"key":"2024052110574889000_22.3.95.15","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.124.5.460"},{"key":"2024052110574889000_22.3.95.16","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1111\/acps.12911","article-title":"Characteristics of depressive and bipolar disorder patients with mixed features","volume":"138","author":"Tondo","year":"2018","journal-title":"Acta Psychiatr Scand"},{"key":"2024052110574889000_22.3.95.17","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jaac.2018.06.034","article-title":"Pathways of association between childhood irritability and adolescent suicidality","volume":"58","author":"Orri","year":"2019","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"2024052110574889000_22.3.95.18","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.cpr.2017.01.009","article-title":"Defining and measuring irritability: construct clarification and differentiation","volume":"53","author":"Toohey","year":"2017","journal-title":"Clin Psychol Rev"}],"container-title":["Evidence Based Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/ebmental-2019-300100","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T18:04:15Z","timestamp":1716314655000},"score":1,"resource":{"primary":{"URL":"https:\/\/mentalhealth.bmj.com\/lookup\/doi\/10.1136\/ebmental-2019-300100"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,27]]},"references-count":18,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,7,23]]},"published-print":{"date-parts":[[2019,8]]}},"alternative-id":["10.1136\/ebmental-2019-300100"],"URL":"https:\/\/doi.org\/10.1136\/ebmental-2019-300100","relation":{},"ISSN":["1362-0347","1468-960X"],"issn-type":[{"value":"1362-0347","type":"print"},{"value":"1468-960X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,27]]}}}