Dysphoria spectrum in the evaluation of suicide risk: An overview and exploratory study

Background: The aim of the present paper was to summarize the role of dysphoria in the development of suicidality. We performed an exploratory study to evaluate dysphoria dimensions in inpatients suffering from  borderline personality disorder (BPD), mood disorders, and schizophrenia spectrum disorders who were evaluated due to suicidal ideation or suicide attempt. Subjects and methods: Subjects aged 18-70, diagnosed with BPD, mood disorders, or schizophrenia spectrum disorders according to the DSM-5 criteria who were hospitalized following suicidal ideation or suicidal attempt were recruited in the present study. Dysphoria was assessed by the Nepean Dysphoria Scale, Italian version (NDS-I), a 24-item auto-administered tool evaluating the different dimensions of dysphoria. Between-group comparisons were performed by means of the Chi-square and Mann-Whitney U test. Results: In the present sample (n=30), 15 (50%) subjects were admitted following a suicide attempt and 15 (50%) presented suicidal ideation. There were no significant differences in the NDS-I scores between subjects who  performed a suicide attempt and those who presented suicidal ideation, neither for the total score nor for the subscales. Subjects suffering from BPD scored significantly higher at the NDS-I than those who were diagnosed with a mood disorder or a schizophrenia spectrum disorder. The result was replicated for the NDS-I subscales, except for the one analyzing discontent. When comparing subjects suffering from mood disorders to those with  a diagnosis schizophrenia spectrum disorders, the two subgroups did not differ except for the irritability subscale, where subjects with mood disorders scored significantly higher. Conclusions: The dimension of dysphoria should be evaluated when assessing subjects who display high suicide risk. Dysphoria could be reconsidered a third affective pole representing psychopathological correlate of  suicidality in subjects suffering from BPD.