Factors Associated With Suicide Attempts in 648 Patients With Bipolar Disorder in the Stanley Foundation Bipolar Network. [CME]
J Clin Psychiatry 2003;64:506-515
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Clinical factors related to
suicide and suicide attempts have been studied much more
extensively in unipolar depression compared with bipolar
disorder. We investigated demographic and course-of-illness
variables to better understand the incidence and potential
clinical correlates of serious suicide attempts in 648
outpatients with bipolar disorder.
Method: Patients with bipolar I or II
disorder (DSM-IV criteria) diagnosed with structured interviews
were evaluated using self-rated and clinician- rated
questionnaires to assess incidence and correlates of serious
suicide attempts prior to study entry. Clinician prospective
ratings of illness severity were compared for patients with and
without a history of suicide attempt.
Results: The 34% of patients with a
history of suicide attempts, compared with those without such a
history, had a greater positive family history of drug abuse and
suicide (or attempts); a greater personal history of early
traumatic stressors and more stressors both at illness onset and
for the most recent episode; more hospitalizations for
depression; a course of increasing severity of mania; more Axis
I, II, and III comorbidities; and more time ill on prospective
follow-up. In a hierarchical logistic regression, a history of
sexual abuse, lack of confidant prior to illness onset, more
prior hospitalizations for depression, suicidal thoughts when
depressed, and cluster B personality disorder remained
significantly associated with a serious suicide attempt.
Conclusion: Our retrospective findings,
supplemented by prospective follow-up, indicate that a history of
suicide attempts is associated with a more difficult course of
bipolar disorder and the occurrence of more psychosocial
stressors at many different time domains. Greater attention to
recognizing those at highest risk for suicide attempts and
therapeutic efforts aimed at some of the correlates identified
here could have an impact on bipolar illness-related morbidity