Suicidal ideation at psychiatric emergency presentation predicts trajectories of functional disability and symptom burden in mood and anxiety disorders: A prospective cohort study.

Suicidal ideation (SI) is common among patients presenting to psychiatric emergency departments (EDs), yet its association with longer-term clinical and functional outcomes remains insufficiently understood. This study examined trajectories of functional disability, depressive and anxiety symptoms, and alcohol misuse among patients with mood and anxiety disorders according to SI at ED presentation. Data were drawn from a prospective cohort of 261 adults with mood and anxiety disorders presenting to a psychiatric ED and followed for 12 months. Linear mixed-effects models examined longitudinal outcomes according to baseline SI, adjusting for sociodemographic, clinical, and psychosocial factors. A secondary analysis examined longitudinal associations between time-varying SI and depressive symptoms. Baseline SI was associated with greater functional disability and more severe depressive and anxiety symptoms throughout follow-up, but not with alcohol misuse. Time-by-SI interactions were nonsignificant for all outcomes, indicating similar trajectories regardless of baseline SI. Depressive and anxiety symptoms improved over follow-up, whereas functional disability increased at discharge before stabilizing, and alcohol misuse decreased only at 12 months. Poor sleep satisfaction, chronic physical illness, and higher impulsivity were associated with poorer outcomes. Male sex and religious or spiritual coping were associated with lower functional disability and/or fewer depressive and anxiety symptoms. Older age was associated with lower alcohol misuse. Time-varying SI was associated with depressive symptoms at both within- and between-person levels. SI at psychiatric ED presentation may identify patients with sustained clinical and functional burden despite similar patterns of change over time, supporting comprehensive assessment and post-discharge monitoring alongside suicide-risk assessment.