Depressive bipolar patients have highest post-discharge suicide risk

By Laura Cowen, medwireNews Reporter

Patients hospitalised with bipolar disorder are at the greatest risk of suicide immediately after discharge, and the rate at which the risk declines depends on the illness phase, Finnish researchers report.

Erkki Isometsä and colleagues from the University of Helsinki found that patients hospitalised with depressive episodes had the highest suicide risk immediately after discharge, as well as the steepest decline in risk.

Those with mixed episodes had a lower immediate suicide risk, which declined more slowly than that observed in the patients with depression.

These findings are noteworthy because the incidence of suicide attempts in patients with bipolar disorder “is known to be highest in mixed episodes”, the researchers remark. They suggest depressive relapse after discharge as an explanation for the higher rates observed among the patients hospitalised for depressive episodes.

Furthermore, “[p]atients hospitalized for manic or mixed episodes generally receive adequate pharmacotherapy, whereas quality of treatment for bipolar depression may often be poor and the available treatments leave room for improvement”, say Isometsä and co-authors.

The lowest suicide risk, which remained relatively stable over time, was among patients with manic episodes.

The findings are based on 466 completed suicides occurring after 52,747 psychiatric hospital discharges in 13,581 patients admitted between 1987 and 2003 in Finland.

The researchers also looked at factors modifying suicide risk in the first 120 days after discharge in a subgroup of 9635 discharges following hospitalisation for depressive episodes (with 65 completed suicides), which occurred between 1995 and 2003.

In this group, patients who had attempted suicide immediately before or during the most recent depressive episode were 8.1 times more likely to commit suicide in the first 120 days after discharge than those who had not.

Men hospitalised with depression had a 3.6-fold higher suicide risk than women hospitalised with depression, while the overall risk was substantially reduced among patients taking lithium (hazard ratio =0.186).

Writing in Bipolar Disorders, the authors conclude: “For purposes of suicide prevention, the implications [of these findings] are clear. In the post-discharge period for bipolar patients, those hospitalized for depression comprise the group with the highest immediate risk (in the first three months) for suicide.”

They add that “particular attention should be paid to preventive efforts in men.”

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