Italian researchers have identified clinical and psychologic characteristics that could help predict the risk for suicide in patients with bipolar disorder.
Their findings confirm a history of suicide attempt as the greatest predictor of future attempts, but also suggest an increased risk among younger individuals and those with personality disorder traits and long periods of depression.
“These characteristics are potentially identifiable when the patient presents for treatment and can be addressed with intensive care by clinicians,” say the researchers, led by Alessandro Serretti, from the University of Bologna.
They investigated predictors of suicidal behavior in 3083 patients with bipolar disorder participating in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Of these patients, eight (0.3%) died by suicide and 132 (4.3%) attempted suicide during follow-up. The suicidal event occurred within the first 6 months for 53 (37.9%) patients and within a year for 96 (68.6%).
In line with previous research, a positive history of suicide attempt was the strongest predictor of a future suicidal event, increasing the risk 2.6-fold.
But there were additional risk factors that remained significant in regression analyses. These were having a score above 36 on the Personality Diagnostic Questionnaire and spending a high percentage of days depressed in the preceding year, which increased the risk for future suicide events 1.96-fold and 1.01-fold, respectively.
The finding that depression predicts suicidal behavior concurs with previous research showing that “suicide in bipolar patients occurs prevalently during the depressive and mixed state of the disorder,” Serretti et al write in the Journal of Psychiatric Research.
And it “reinforces the importance of treating depression in [bipolar disorder],” they stress.
Age also predicted future suicidal events, with patients more likely to engage in suicidal behavior when young. For those older than 40 years, the risk for future suicide events decreased by 43%.
Other factors that were associated with an increased risk for suicidal events but that did not reach significance were comorbid substance use disorders and obsessive–compulsive disorder.
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