Original article Psychopathological characteristics and adverse childhood events are differentially associated with suicidal ideation and suicidal acts in mood disorders Delfina Janiri a , Pietro De Rossi b,c,d , Georgios D. Kotzalidis b , Paolo Girardi b,c , Alexia Emilia Koukopoulos b,c,d , Daniela Reginaldi c , Francesco Dotto e , Giovanni Manfredi b,c , Fabrice Jollant f,g , Philip Gorwood f,g , Maurizio Pompili b, 1 , Gabriele Sani b,c, * , 1 a Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy b School of Medicine and Psychology, NESMOS Department (Neuroscience, Mental Health and Sensory Organs) Sapienza University, Sant’Andrea Hospital, Via di Grottarossa 1035-1038, 00189, Rome, Italy c Centro Lucio Bini-Aretæus, via Crescenzio 42, 00193 Rome, Italy d Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy e Department of Economics, Università degli studi di Roma Tre, Rome, Italy f INSERM U894, Centre de Psychiatrie et Neurosciences (CPN), Université Paris Descartes, Sorbonne Paris Cité, Paris, France g CH Sainte-Anne, Clinique des Maladies Mentales et de l’Encéphale (CMME), Paris, France A R T I C L E I N F O Article history: Received 25 March 2018 Received in revised form 20 May 2018 Accepted 23 May 2018 Available online 4 June 2018 Keywords: Affective temperaments Childhood trauma Depression Emotional abuse Mood disorders Suicide attempts Suicidal ideation A B S T R A C T Background: Depression is an important risk factor for suicide. However, other dimensions may contribute to the suicidal risk and to the transition from ideas to acts. We aimed to test the relative involvement of hopelessness, temperament, childhood trauma, and aggression in suicide risk in a large sample of patients with mood disorders. Methods: We assessed 306 patients with major depressive and bipolar disorders for clinical characteristics including hopelessness, temperament, childhood trauma, and aggression. We tested their associations with suicidal ideation and acts using standard univariate/bivariate methods, followed by multivariate logistic regression models. Results: In multivariate analyses, the loss of expectations subscore of the hopelessness scale was associated with lifetime suicidal ideation but not suicide attempt. Childhood emotional abuse, severity of current depression, and female gender were associated with lifetime suicide attempts, whereas hyperthymic temperament was protective. Only hyperthymic temperament differentiated patients with a history of suicidal ideas vs. those with a history of suicide attempt. Conclusions: Findings support the association of hopelessness with suicidal ideation and point to considering in suicidal acts not only depression, but also childhood emotional abuse, hyperthymic temperament, and gender. © 2018 Elsevier Masson SAS. All rights reserved. 1. Introduction More than 800 000 people die of suicide every year, representing one death every 40 s, and 20 times more people attempt suicide (WHO data, accessed on December 23, 2017 at http://www.who.int/ gho/mental_health/suicide_rates/en/). Rates of suicide are 5–20 times greater among patients with a major mood disorder than in the general population [1–4] for both major depressive disorders (MDD) [4,5] and bipolar disorders (BD) [1,6]. However, not all patients with a mood disorder are equal toward suicidal risk as 90% of them will not die from suicide and more than 50% will not attempt suicide [7–9]. Hence, improving our ability to assess suicide risk among patients with a mood disorder is an important focus point. To tackle this issue, one approach has been to consider not only the clinical course [10–12] but also particular psychopathological * Corresponding author at: Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), School of Medicine and Psychology, Sapienza University À Rome Sant’Andrea Hospital, Psychiatry Service, Via di Grottarossa 1035-1039, 00189, Rome, Italy. E-mail address: gabriele.sani@uniroma1.it (G. Sani). 1 These authors contributed equally to this paper. http://dx.doi.org/10.1016/j.eurpsy.2018.05.009 0924-9338/© 2018 Elsevier Masson SAS. All rights reserved. European Psychiatry 53 (2018) 31–36 Contents lists available at ScienceDirect European Psychiatry journal homepage: http://www.europsy- journal.com