Attempted Suicide in Bipolar Disorder: Risk Factors in a Cohort of 6086 Patients

Abstract

ObjectiveBipolar disorder is associated with high risk of self-harm and suicide. We wanted to investigate risk factors for attempted suicide in bipolar patients.MethodThis was a cohort study of 6086 bipolar patients (60% women) registered in the Swedish National Quality Register for Bipolar Disorder 2004–2011 and followed-up annually 2005–2012. Logistic regression was used to calculate adjusted odds ratios for fatal or non-fatal attempted suicide during follow-up.ResultsRecent affective episodes predicted attempted suicide during follow-up (men: odds ratio = 3.63, 95% CI = 1.76–7.51; women: odds ratio = 2.81, 95% CI = 1.78–4.44), as did previous suicide attempts (men: odds ratio = 3.93, 95% CI = 2.48–6.24; women: odds ratio = 4.24, 95% CI = 3.06–5.88) and recent psychiatric inpatient care (men: odds ratio = 3.57, 95% CI = 1.59–8,01; women: odds ratio = 2.68, 95% CI = 1.60–4.50). Further, those with many lifetime depressive episodes were more likely to attempt suicide. Comorbid substance use disorder was a predictor in men; many lifetime mixed episodes, early onset of mental disorder, personality disorder, and social problems related to the primary group were predictors in women.ConclusionThe principal clinical implication of the present study is to pay attention to the risk of suicidal behaviour in bipolar patients with depressive features and more severe or unstable forms of the disorder.

Psychosocial Factors and Comorbidity Associated with Suicide Attempts: Findings in Patients with Bipolar Disorder

“…Strong evidence supports the impact of any type of abuse (physical, emotional, sexual, or neglect), particularly at younger ages, with the emergence of mental illness [31] . The presence of current stressors was not found to be associated with HSA, in contrast to a study [13] which proposed significant effects of multiple social factors on suicide attempts in women. However, our HSA data obtained at intake was historical, while the stressor measure was compiled from each subsequent session.…”

“…Several authors reported an association between substance abuse and suicide attempts in patients with BD [12,13] , specifically alcohol overuse [14] , but Cassidy [6] did not find a similar correlation. An anxiety diagnosis comorbid with BD was associated with increased HSA in some studies [14,15] but not in others [16] .…”

Suicide attempts in bipolar I patients: impact of comorbid personality disorders

“…Existing evidence indicates that fewer suicides are attempted during manic episodes. 31 Therefore, motor impulsivity does not appear to be associated with SA as a trait or state characteristic. Moreover, according to a recent review of impulsivity and suicidality in BD, SAs in patients with higher motor impulsivity tend to be less lethal.…”

Personality disorders in euthymic bipolar patients: a systematic review

“…8,[46][47][48] With respect to treatment, although antipsychotics and mood stabilizers seem to improve global functioning in patients with borderline and/or schizotypal PD, 49 few studies have addressed concurrent medical and psychological treatment in bipolar patients with comorbid PD. In this context, lamotrigine and valproate may alleviate symptoms of both BD and borderline PD, 50 and psychoeducation seems useful as an adjunctive treatment in the prophylaxis of BD with any comorbid PD.…”