Correlates of Historical Suicide Attempt in Rapid-Cycling Bipolar Disorder

Abstract

Objective A rapid-cycling course in bipolar disorder has previously been identified as a risk factor for attempted suicide. This study investigated factors associated with suicide attempts in patients with rapid-cycling bipolar I or II disorder. Method Cross-sectional data at the initial assessment of patients who were enrolled into 4 clinical trials were used to study the factors associated with suicide attempt. An extensive clinical interview and the Mini-International Neuropsychiatric Interview were used to ascertain DSM-IV diagnoses of rapid-cycling bipolar disorder, substance use disorders, anxiety disorders, psychosis, and other clinical variables. Chi-square, t test, and logistic regression or Poisson regression were used to analyze the data where appropriate, with odds ratios (ORs) for relative risk estimate. The data were collected from September 1995 to June 2005. Results In a univariate analysis, 41% of 561 patients had at least 1 lifetime suicide attempt. Earlier age of depression onset, bipolar I subtype, female sex, unmarried status, and a history of drug use disorder, panic disorder, sexual abuse, and psychosis were associated with significantly higher rates of attempted suicide (all p<.05). After considering 31 potential confounding factors in the stepwise logistic regression model (n = 387), any Axis I comorbidity (OR=2.68, p = .0219), female sex (OR= 2.11, p = .0005), psychosis during depression (OR = 1.84, p = .0167), bipolar I subtype (OR= 1.83, p = .0074), and history of drug abuse (OR = 1.62, p = .0317) were independent predictors for increased risk of attempted suicide. However, white race was associated with a lower risk for suicide attempt (OR = 0.47, p = .0160). Psychosis during depression (p = .0003), bipolar I subtype (p = .0302), and physical abuse (p = .0195) were associated with increased numbers of suicide attempts by 248%, 166%, and 162%, respectively; white race was associated with a 60% decrease in the number of suicide attempts (p=.0320). Conclusion In this highly comorbid group of patients with rapid-cycling bipolar disorder, 41% had at least 1 suicide attempt. Among the demographics, female sex was positively associated, but white race was negatively associated, with the risk for suicide attempt. Independent clinical variables for increased risk and/or number of attempted suicides were any Axis I comorbidity, psychosis during depression, bipolar I subtype, a history of drug abuse, and physical abuse.

Multimodal Neuroimaging of Frontolimbic Structure and Function Associated With Suicide Attempts in Adolescents and Young Adults With Bipolar Disorder

“…The white matter decreases observed herein in attempters included more caudal frontal and temporal areas and were not associated with impulsivity. Right uncinate fractional anisotropy values were lower in association with rapid-cycling, a suggested risk factor for suicide in bipolar disorder (33), and suggests a link to mood dysregulation. Decreased white matter volumes have been observed in cerebellum in attempters with major depression (31).…”

Independent Predictors for Lifetime and Recent Substance Use Disorders in Patients with Rapid‐Cycling Bipolar Disorder: Focus on Anxiety Disorders

“…A “recent” SUD was defined as having a diagnosis of substance dependence and continuing to meet abuse or dependence criteria for a substance(s) in the last 6 months at the time of initial assessment or having a diagnosis of substance abuse and continuing to abuse a substance(s) in the previous 3–6 months. The study design, inclusion and exclusion criteria, mood state at study entry, and the stage of each study at the time of this analysis are summarized elsewhere 19,23 …”

“…The study design, inclusion and exclusion criteria, mood state at study entry, and the stage of each study at the time of this analysis are summarized elsewhere. 19,23…”

The Threshold Bias Model: A Mathematical Model for the Nomothetic Approach of Suicide

“…Several authors have related suicidal behaviors with bipolar and rapid-cycling bipolar disorder [45], [46], and the hypotheses previously discussed are compatible with the sensitization/kindling model proposed by Post and colleagues [47], [48]. These authors consider that young individuals with untreated unipolar depression can develop rapid-cycling bipolar disorder as a consequence of repeating episodes of strong emotional stress across their lifetimes.…”