Risk factors pave way for tailored substance use prevention in bipolar disorder

By Lucy Piper, Senior medwireNews Reporter

Researchers have identified risk factors that may help clinicians identify bipolar disorder patients who are at increased risk for substance use disorders (SUDs).

They found that bipolar disorder patients were more likely to develop secondary SUDs if they were male, had a lifetime oppositional defiant disorder, any lifetime anxiety disorder, adolescent-onset bipolar disorder, or had attempted suicide.

"Early identification of bipolar disorder, along with treatment and prevention strategies tailored toward the patient's risk factors may prevent the development of SUD, and thereby decrease the morbidity and mortality of people with bipolar disorder," say Aileen Kenneson, from Syracuse Veteran's Affairs Medical Center in New York, USA, and colleagues.

The greatest risk factor was having a history of one or more suicide attempts.

"About two-thirds of individuals with bipolar disorder and a history of a suicide attempt had comorbid lifetime SUD in our study population," the researchers report. Moreover, "50% of those with a suicide attempt subsequently developed SUD," they add, and the strong association between suicide attempts and SUD remained significant after accounting for the other risk factors.

The team used data collected from the National Comorbidity Survey Replication study on 158 individuals with childhood-onset (<13 years) or adolescent-onset (13-18 years) primary bipolar disorder.

SUD was not present at the time of bipolar disorder onset in 98.3% of the 60 patients with childhood onset disorder and in 75.0% of the 132 with adolescent-onset disorder.

Among the participants, half were male, around 30% had a lifetime oppositional defiant disorder, and 80% had any lifetime anxiety disorder.

Survival analysis showed that males were more likely to develop SUDs than females, and at a faster rate. The researchers suggest in Comprehensive Psychiatry that this is partly due to a higher rate of multiple risk factors among men than women.

After stratifying for gender, hazard ratios for the other risk factors were 15.42 for bipolar disorder patients who had made a suicide attempt, 3.07 for those with any lifetime anxiety disorder, 2.05 for a lifetime oppositional defiant disorder, and 1.65 for those with adolescent- versus childhood-onset disorder.

By contrast, SUDs were not predicted by bipolar disorder type, family history of bipolar disorder, hospitalization for a mood episode, attention deficit/hyperactivity disorder, or conduct disorder.

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