Correlates of suicide attempt history in bipolar disorder: a stress‐diathesis perspective

Abstract

Aggressive traits and early treatment of mood disorders, especially major depressive episodes, are potential targets for suicide prevention in bipolar disorder.

Does first episode polarity predict risk for suicide attempt in bipolar disorder?

“…This was not explained by years ill, lifetime number of major depressive episodes, or BD-I vs. II/NOS subtype. Hostility was associated with suicide attempt risk, consistent with previous reports from our group (Grunebaum et al, 2006;Oquendo et al, 2000). Reasons for living appeared to be an important protective factor.…”

Suicidal ideation and suicide attempts in bipolar disorder type I: an update for the clinician

“…34,42 Lifetime aggressiveness is reported to be also higher in previous attempters. 30,55 Impulsivity seems to play a different role in bipolar patients. In other psychiatric conditions (e.g., major depression), impulsivity is associated with suicide attempts.…”

“…42 Grunebaum et al evaluated 96 patients with bipolar disorder and observed that the percentage of attempters reporting a history of physical or sexual abuse was twice as much as among non-attempters, although this variable was not retained in the regression analysis. 55 One interesting point about physical and sexual abuse is that in a family study the rates of childhood abuse were higher in probands with a family history of suicidal behavior 79,80 and a history of sexual abuse in either the parents 81 or the offspring predicted suicidal behavior in offspring. 79 9) Family history Several family studies have found that the higher risk of suicidal behavior conferred holds true even after controlling for the effects of psychiatric disorders.…”

“…49 Grunebaum et al showed that suicide attempters had a nearly 9-year earlier age of onset for a first mood episode when compared to patients without attempts. 55 Tondo et al found an estimated age of onset 6 years lower in individuals with suicide attempts. 56 Leverich et al evaluated 648 bipolar patients in a naturalistic follow-up study and found that attempters had an earlier age of onset of bipolar disorder when compared to non attempters (17.2 versus 20.6 years).…”

“…58 In several studies, the number of hospitalizations for depression was also an independent predictive risk factor. 48,49,55 Although the severity of depression is a risk factor as well, studies have previously shown that prior suicidal behavior does not appear to be related only to the objective severity of depression, i.e., the clinician's rating of how severe is the depression as measured by depression rating scales such as the Montgomery-Asberg Depression Rating Scale (MADRS) 59 and the Hamilton Depression Rating Scale (HAM-D). 60 Instead, evaluating subjective reports of depression severity (the patient's rating of how severe the depression is as measured by self reported instruments such as the Beck Depression Inventory), 61 hopelessness and perceived reasons for living might provide clinicians with a better indicator of the level of risk for suicidal behavior.…”