Risk factors for suicide in bipolar disorder: a cohort study of 12 850 patients

Hansson, Caroline; Joas, Erik; Pålsson, Erik; Hawton, Keith; Runeson, Bo; Landén, Mikael

doi:10.1111/acps.12946

Cited by 48 publications

(39 citation statements)

References 29 publications

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“…In general, these studies found 4% to 8% of their bipolar patients having died by suicide. The study of Hansson et al (28) was included, even though it is based on a national Swedish quality register (BipoläR), from which patients can (by law) opt out. This study found significantly lower suicide mortality in 2004-2014 among patients included ( Table 2).…”

Section: Suicide Deaths In Bipolar Disordermentioning

confidence: 99%

Suicides in Mood Disorders in Psychiatric Settings in Nordic National Register–Based Studies

Isometsä

2020

Front. Psychiatry

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Objective: Although risk factors for nonfatal suicidal behavior in mood disorders have been vastly investigated, rate and risk factors of suicide deaths are less well known. Extensive health care and other population registers in the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) allow national-level studies of suicide rates and risk factors. This systematic review examined Nordic studies of suicide in mood disorders. Methods: National Nordic studies published after 1.1.2000 reporting on suicide mortality or relative risk in diagnosed unipolar depression or bipolar disorder treated in psychiatric settings; temporal variations in suicide risk after discharge, or risk factors for suicide were systematically reviewed. Results: Altogether 16 longitudinal studies reported on rate and risk of suicide in depression. They found 2%-8% of psychiatric inpatients with depression to have died by suicide. However, in Finland suicide risk among depressive inpatients halved since the early 1990s. Nine studies investigated suicide risk in bipolar disorder, finding 4-8% of patients having died by suicide in long term. The relative risk of suicide was consistently found extremely high (SMR > 100) during the first weeks postdischarge, declining steeply over time to approximately SMR of five after five years. Male gender, preceding suicide attempts, high severity of depression and substance abuse were found risk factors for suicide in depression, with only minor gender differences in risk factors, but major differences in lethal methods. Three studies investigated risk factors for suicide in bipolar disorder, finding male gender, preceding suicide attempts, and depressive episodes and psychiatric comorbidity to be associated with risk. Conclusions: Overall, of psychiatric inpatients with depressive of bipolar disorders in the Nordic countries, 2%-8% have died by suicide in the last few decades, but current rates may be lower. Suicide risk is approximately similar or somewhat higher among patients with bipolar disorder, risk factor studies of whom are fewer. Risk of suicide is remarkably high immediately after discharge, and higher among males than females, those with preceding suicide attempts, high severity of depression, or concurrent substance abuse. Generalizability of findings from these Nordic studies to other countries need to be investigated, and their methodological limitations understood.

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Section: Suicide Deaths In Bipolar Disordermentioning

confidence: 99%

Suicides in Mood Disorders in Psychiatric Settings in Nordic National Register–Based Studies

Isometsä

2020

Front. Psychiatry

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“…Diagnostic ICD-10 codes provided in the Appendix 8 Somatic specialist medical inpatient treatment because of serious suicide attempts. Diagnostic ICD-10 codes provided in the Appendix 9 Results from Fisher's Exact Test (F) 9 Results from Pearson Chi-Square Tests (χ 2 ) 10 Results from Mann Whitney U-test (U) 11 n (%) = number (percent) of patients in each group digestive system (n = 5, 3.2%, ICD-10: chapter K). The somatic diagnoses in suicide cases and controls are specified in the Appendix.…”

Section: Provision Of Somatic Inpatient Carementioning

confidence: 99%

“…It is important to note that around 90% of individuals who commit suicide have a documented history of a psychiatric disease [6][7][8]. The psychiatric disorders with a high lifetime risk of suicide are the affective disorders [9], particularly bipolar disorder [10], alcohol or substance use disorders [11,12], schizophrenia [13,14], and personality disorders [15,16]. Indeed, previous research has emphasized treatment interventions for psychiatric illness to reduce suicidal ideation and suicidal behavior.…”

Section: Introductionmentioning

confidence: 99%

Are quantity and content of psychiatric interventions associated with suicide? A case-control study of a Swedish sample

et al. 2020

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Background: Research is required to identify those psychiatric interventions with a protective effect against suicide. The overarching aim of the current study was to examine whether completed suicide in psychiatric patients in a Swedish population was associated with the quantity and nature of previous medical and psychosocial treatment interventions. Methods: This retrospective case-control study (n = 308) compared a group of deceased psychiatric patients with matched controls. For every case of suicide, a control was found within psychiatry that matched according to sex, age, and primary psychiatric diagnosis. A stepwise forward logistic regression model with suicide as the dependent outcome variable was used. Results: Receiving pharmacotherapy combined with psychotherapy [OR: 0.44 (95% CI: 0.226-0.876), p = 0.019] and a higher number of outpatient visits in psychiatry [OR: 0.99 (95% CI: 0.982-0.999), p = 0.028] were negatively associated with suicide. These associations were still significant after controlling for previous serious suicide attempts and somatic comorbidity. Conclusions: Frequent visits and pharmacotherapy combined with psychotherapy seem to be important for preventing suicide in psychiatric patients. The reasons for not receiving such therapy are important issues for further study.

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“…Due to the early onset of the disease, high rates of selfin icted injury and hospitalization, and the negative stigma of BPD, the disease causes signi cant social and economic burden [1][2]. It was previously reported that the risk of suicide was 20-times higher in patients with BPD than the more general population [3][4][5][6]. In addition, the clinical symptoms of BPD overlap with those of many other mood disorders, including major depressive disorder (MDD), schizophrenia, and attention de cit and hyperactivity disorder (ADHD) [7].…”

Section: Introductionmentioning

confidence: 99%

Identification of bipolar disorder using a combination of multimodality magnetic resonance imaging and machine learning techniques

Cui

Cao³

et al. 2020

Preprint

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Background: Bipolar disorder (BPD) is a common mood disorder that is often goes misdiagnosed or undiagnosed. Recently, machine learning techniques have been combined with neuroimaging methods to aid in the diagnosis of BPD. However, most studies have focused on the construction of classifiers based on single-modality MRI. Hence, in this study, we aimed to construct a support vector machine (SVM) model using a combination of structural and functional MRI, which could be used to accurately identify patients with BPD.Methods: In total, 44 patients with BPD and 36 healthy controls were enrolled in the study. Clinical evaluation and MRI scans were performed for each subject. Next, image pre-processing, VBM and ReHo analyses were performed. The ReHo values of each subject in the clusters showing significant differences were extracted. Further, LASSO approach was recruited to screen features. Based on selected features, the SVM model was established, and discriminant analysis was performed.Results: After using the two-sample t-test with multiple comparisons, a total of 8 clusters were extracted from the data (VBM = 6; ReHo = 2). Next, we used both VBM and ReHo data to construct the new SVM classifier, which could effectively identify patients with BPD at an accuracy of 87.5% (95%CI: 72.5-95.3%), sensitivity of 86.4% (95%CI: 64.0-96.4%), and specificity of 88.9% (95%CI: 63.9-98.0%) in the test data (p=0.0022). Limitations: The sample size was small, and we were unable to eliminate the potential effects of medications. Conclusions: A combination of structural and functional MRI can be of added value in the construction of SVM classifiers to aid in the accurate identification of BPD in the clinic.

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Risk factors for suicide in bipolar disorder: a cohort study of 12 850 patients

Cited by 48 publications

References 29 publications

Suicides in Mood Disorders in Psychiatric Settings in Nordic National Register–Based Studies

Suicides in Mood Disorders in Psychiatric Settings in Nordic National Register–Based Studies

Are quantity and content of psychiatric interventions associated with suicide? A case-control study of a Swedish sample

Identification of bipolar disorder using a combination of multimodality magnetic resonance imaging and machine learning techniques

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