Diagnostic and clinical characteristics in psychiatric outpatients with suicidality in the context of irritability

Background: This study examines differences in psychiatric diagnoses and clinical symptoms between patients with suicidality with and without irritability, while also exploring the moderating role of sex on these distinctions. Methods: Medical records of 6118 psychiatric outpatients in South Korea, including structured clinical interviews and standardized rating scales, were retrospectively reviewed. Patients were categorized into four groups based on the presence or absence of suicidality and irritability: suicidality with irritability (SI group; n = 345), suicidality only (S group; n = 1918), irritability only (I group; n = 283), and neither (N group; n = 3572). Results: Bipolar, substance use, eating, and personality disorders were most prevalent in SI group, whereas depressive disorders were most frequent in S group. Psychotic and neurocognitive disorders predominated in I group, while anxiety, somatic symptom, sleep, and trauma- or stressor-related disorders were most common in N group. SI and S groups exhibited higher depression, anxiety, hopelessness, attention deficits, and alcohol use compared to I and N groups. S group demonstrated greater hopelessness than SI group. SI group showed lower prevalence of depressive disorders and higher bipolarity than S group, with these differences more pronounced in males than females. Somatic symptom disorders in SI group were more frequent in males but less common in females compared to S group. Conclusion: This study highlights diagnostic and symptomatic distinctions among psychiatric outpatients with suicidality, depending on the presence of irritability, and underscores the moderating role of sex. The combination of suicidality and irritability appears to represent a qualitatively distinct clinical manifestation compared to suicidality alone.