Relevance of Family History of Suicide in the Long-Term Outcome of Bipolar Disorders

Soledad Romero, M.D.; Francesc Colom, Ph.D.; Ana-Maria Iosif, M.A.; Nuria Cruz, M.D.; Isabella Pacchiarotti, M.D.; Jose Sanchez-Moreno, Psy.D.; and Eduard Vieta, M.D.

Objective: This study examined the association between family history of completed suicide and suicidal behavior and other clinical variables in subjects with bipolar disorder.

Method: 374 outpatients aged from 19 to 88 years (mean ± SD age = 41.9 ± 4.1 years) (54.3% female) meeting DSM-IV criteria for bipolar disorder type I or II or schizoaffective disorder, bipolar subtype, were included in the study. Forty-eight subjects with a family history of completed suicide were compared to 326 subjects without a family history of completed suicide regarding several clinical and demographic variables. The study was conducted from 2001 to 2004.

Results: There were no statistically significant demographic differences between bipolar disorder subjects with and without a family history of suicide. Bipolar disorder subjects with a family history of suicide showed higher rates of cluster C personality disorders than subjects without a family history of suicide (14.9% vs. 2.5%, OR = 6.72, 95% CI = 2.31 to 19.51, p < .001). Subjects with a family history of suicide also demonstrated a significantly greater lifetime prevalence of suicide attempts (52.2% vs. 25.5%, OR = 3.19, 95% CI = 1.7 to 6.0, p < .001). Results remained significant after controlling for all possible interactions.

Conclusion: Family history of completed suicide is a significant risk factor associated with suicidal attempts in patients with bipolar disorder. These findings underscore the importance of identifying patients with a family history of suicide in order to provide prompt treatment and careful follow-up.

(J Clin Psychiatry 2007;68:1517-1521)

Received Aug. 23, 2006; accepted Jan. 10, 2007. From the Institute of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (Drs. Romero, Colom, Cruz, Pacchiarotti, Sanchez-Moreno, and Vieta); and the Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pa. (Dr. Romero and Ms. Iosif).

This study was supported by grants from the Spanish Ministry of Health, Instituto de Salud Carlos III (FIS:PI050206), and RETICS RD06/001 (REM-TAP Network), Spain, and Stanley Medical Research Institute, Bethesda, Md. Dr. Romero has a 2-year fellowship from the Alicia Koplowitz Foundation, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pa.

The authors acknowledge Boris Birmaher, M.D., Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pa., for advice and mentoring in the preparation of the manuscript, and Aamer Malik and Benjamin Goldstein, M.D., University of Pittsburgh Medical Center, for editorial support. The acknowledged individuals report no financial or other relationship relevant to the subject of this article.

Dr. Colom is a member of the speakers/advisory boards for AstraZeneca, Eli Lilly, and Sanofi. Dr. Vieta is a consultant for AstraZeneca, Bial, Bristol-Myers Squibb, Eli Lilly, Janssen, Lundbeck, Novartis, Organon, Pfizer, Sanofi-Aventis, Servier, and UCB Pharma; has received grant/research support from AstraZeneca, Bial, Eli Lilly, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sanofi-Aventis, and Servier; and is a member of the speakers/advisory boards of AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen, Novartis, and Pfizer. Drs. Romero, Cruz, Pacchiarotti, and Sanchez-Moreno and Ms. Iosif report no additional financial or other relationship relevant to the subject of this article.

Corresponding author and reprints: Eduard Vieta, M.D., Bipolar Disorders Program, Institute of Neuroscience, IDIBAPS Hospital Clinic, University of Barcelona, Villarroel 170, Barcelona, 08036, Spain (e-mail: evieta@clinic.ub.es).